Clinical Characteristics And Risk Factors Of Patients With Chronic Obstructive Pulmonary Disease-associated Pulmonary Hypertension

BackgroundChronic obstructive pulmonary disease(COPD)is a chronic respiratory inflammatory disease,but it has become the fourth leading cause of death globally.The common cause of death of COPD is related to Complications,which can affect the patient’s disease burden and survival rate.Pulmonary hypertension(PH)is one of the common complications of COPD.The incidence of chronic obstructive pulmonary disease-associated pulmonary hypertension(COPD-PH)is 20%to 91%.The rise of pulmonary arterial pressure will increase the acute exacerbation,poor prognosis and death risk of COPD patients,greatly increasing the economic burden and social burden.Therefore,Screening PH in COPD patient,which plays an important role in controlling the progression of the disease and improving the prognosis of patients.In addition,the COPD diagnosis and treatment guidelines do not indicate whether all COPD patients need to be screened for PH in the initial evaluation and follow-ups.The population characteristics and risk factors of COPD-PH are still unclear.Therefore,identifying the risk factors for COPD-PH and intervening it as soon as possible has a positive effect on reducing patient mortality and improving patients’ quality of life.purposeAnalyze the clinical characteristics and risk factors of in COPD-PH patients,to explore potential predictors of COPD-PH,and provide basis for the intervention of COPD progression and management.methodContinuous selection of COPD patients admitted to the Department of Respiratory Medicine of the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2019,after screening for inclusion and exclusion criteria,482 patients were finally included.According to whether they were combined with PH,they were divided into COPD-PH group(132 cases)and COPD group(350 cases).Collected patient’s socio-demographic characteristics(gender,age,height,weight,comorbid disease,smoking history,duration of disease),laboratory data(blood routine,inflammation indicators,blood biochemistry,blood gas analysis,myocardial enzymes and brain natriuretic peptide,coagulation function)and lung function examination,doppler echocardiography,chest CT reaults.SPSS 22.0 software was used to analyze datas.compared the differences of general information,laboratory indexes and lung function indexes between patients in COPD-PH group and COPD group;analyzed the correlation between pulmonary artery systolic pressure(PASP)with different indexes;Logistic regression analysis of risk factors for COPD-PH;drew receiver operating characteristic(ROC)curve and analyzed of the diagnostic efficacy of various indicators for COPD-PH.result1.General information of the two groups of patients:the average age and the proportion of combined diabetes of the COPD-PH group were higher than that of the COPD group,which were(68.64±8.92 vs 64.38±9.02)years old,(28/104 vs 38/312),the difference was statistically significant(P<0.05).2.Analysis of laboratory results:Blood gas analysis showed that,PaCO2 and AB in the COPD-PH group were higher than those in the COPD group,respectively(52.60±13.93 vs 46.93±8.37)mmHg,(28.26±3.91 vs 26.82±3.21)mmol/L,the difference was statistically significant(P<0.05).Compared with the COPD group,the neutrophil/lymphocyte ratio and red blood cell distribution width were higher and platelet count was lower in the COPD-PH group,which were[2.66(1.85,4.05)vs 3.53(2.15,5.58)],(13.80±1.20 vs 14.21 ± 1.28)%,(222.35±77.47 vs 204.11±67.87)10^9/L,the difference was statistically significant(P<0.05).Comparing inflammation indicators,it can be seen that c-reactive protein of COPD-PH group was higher than that of COPD group[8.56(3.55,30.13)vs 4.69(1.26,15.34)mg/L],the difference was statistically significant(P<0.05).Comparing the blood biochemical indicators,compared with the COPD group,the COPD-PH group had lower albumin and A/G and higher globulin,respectively(39.92±4.85 vs 37.96±3.98)g/L,(1.68±0.39 vs 1.49±0.31),(24.76±4.86 vs 26.24±4.69).g/L,the difference was statistically significant(P<0.05).Comparing the differences between BNP,NT-proBNP and myocardial enzymes in the two groups of patients,the COPD-PH group had higher BNP and NT-proBNP than the COPD group,which were(133.54±77.66 vs 76.18±57.35)ng/L and(570.40±266.75 vs 256.70±194.27)ng/L,the difference was statistically significant(P<0.05),the difference of myocardial enzyme index between the two groups was not statistically significant.Comparing the coagulation function of the two groups of patients,the D-dimer of COPD-PH group was higher than that of COPD group[0.16(0.11,0.28)vs 0.11(0.07,0.19)]mg/L,the difference was statistically significant(P<0.05).3.Compared the lung function test indicators of the two groups:FEV1/FVC,FEV1%pred,FVC%pred,DLCO%pred of the COPD-PH group were lower than that of the COPD group,which were(44.86±12.69 vs 48.33± 11.39)%、(44.18±22.42 vs 52.74±19.73)%、(74.69±21.31 vs 84.35±20.11)%、(52.44±27.65 vs 60.11±25.70)%,the difference was statistically significant(P<0.05).4.Correlation analysis of various indicators and PASP,age was positively correlated with PASP(r=0.197,P<0.001),PaCO2 was positively correlated with PASP(r=0.208,P<0.001),RDW was positively correlated with PASP(r=0.182,P<0.001),A/G was negatively correlated with PASP(r=-0.222,P<0.001),BNP was positively correlated with PASP(r=0.0.340,P<0.001),FEV1%pred was negatively correlated with PASP(r=-0.234,P<0.001).5.The use of binary logistic regression analysis of risk factors of COPD-PH,the results suggested that age≥65 years old,with diabetes,A/G decreased,BNP increased,FEV1%pred<50%was risk factors of COPD-PH.6.Comprehensive calculation of these five high-risk factor indicators through binary logistic regression to obtain joint prediction indicators,compared the combined prediction indicators with age,combined diabetes,A/G ratio,BNP level,FEV1%pred indicators for PH prediction accuracy,The results suggested that the AUC for the diagnosis of COPD-PH with the combined predictors was 0.763,the sensitivity was 69.9%,and the specificity was 73.6%;the AUC for age diagnosis of the COPD-PH is 0.648,the sensitivity was 53.6%,and the specificity was 71.6%;the AUC for A/G diagnosis of COPD-PH was 0.662,sensitivity was 80.0%,specificity was 48.9%;the AUC for BNP diagnosis of COPD-PH was 0.736,sensitivity was 59.2%,specificity was 80.9%;the AUC for FEV1%pred diagnosis of COPD-PH was 0.651,the sensitivity was 52.0%,the specificity was 78%,and the diagnostic efficacy of the combined predictor was the highest.conclusion1.patients with age≥65 years old,diabetes mellitus,decreased A/G ratio,increased BNP level,severe pulmonary ventilation function obstacles or above are more likely to combine with PH.PH screening is more necessary for patients with this type of COPD patients.2.After excluding left heart failure,renal failure and other diseases that can increase BNP,BNP has a certain predictive value for COPD-PH.