Research Between Nutritional Risk,Length Of Stay And Clinical Characteristics In Patients With AECOPD Coxbined With Type Ⅱ Respiratory Failure And Treated With NIPPV

Objectives:1.To explore the clinical characteristics on admission and at discharge of patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）complicated by type Ⅱ respiratory failure and treated with noninvasive positive pressure ventilation（NIPPY）,thus providing references for clinical management.2.To analyze influencing factors for nutritional risks and clinical characteristics on admission of AECOPD patients complicated by type Ⅱrespiratory failure and treated with NIPPV,thus providing references for assessing nutritional risks and developing individualized nutritional interventions.3.To analyze the relationship between length of stay（LOS）and clinical characteristics on admission and at discharge of AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPV,thus providing references for predicting their prognosis.Methods:This study was conducted using a cross-sectional survey.Patients with AECOPD complicated by type Ⅱ respiratory failure and treated with NIPPV were chosen from the general wards of three first-class hospitals in Nanchong city.The general data questionnaire,chronic obstructive pulmonary disease test questionnaire（CAT）,modified British Dyspnea Questionnaire（mMRC）,nutritional risk screening scale 2002（NRS 2002）,patient clinical data statistics（admission）,and patient clinical data statistics（discharge）were used to collect data on patient’s admission and discharge.At admission,clinical data collected were:（1）Baseline characteristics:age,gender,etc.CAT scores,mMRC scores,NRS2002 scores;（2）anthropometric indexes:height,weight,and body mass index（BMI）;（3）biochemical indexes:albumin（ALB）,prealbumin（PAB）;（4）blood routine indexes:red blood cell（RBC）,hemoglobin（HGB）,percentage of lymphocytes（LYM%）,the absolute value of lymphocytes（ALC）（5）arterial blood gas analysis（i.e.,partial pressure of oxygen（PaO₂）,partial pressure of carbon dioxide（PaCO₂）,blood oxygen saturation（SaO₂）,and pH value）（6）heart rate（HR）and respiratory rate（RR）.At discharge,clinical data included arterial blood gas analysis（i.e.,partial pressure of oxygen（PaO₂）,partial pressure of carbon dioxide（PaCO₂）,blood oxygen saturation（SaO₂）,and pHvalue）,heart rate（HR）,respiratory rate（RR）,duration of noninvasive positive pressure ventilation,length of stay and hospitalization costs.For statistical analysis,the SPSS 25 software was utilized.General data was represented by descriptive analysis.The numerical data were represented in percentages.The comparison between groups was characterized by the Pearson chi-square test or the Fisher exact probability technique.If the data was normal,the findings were reported as "mean standard deviation"（x±s）,and the t-test was used to compare between groups.The median and interquartile spacing（M（P25,P75））indicate those who do not fit the normal distribution,and the Mann-Whitney U test was used to compare between groups while paired Wilcoxon test was used for intra group comparison.The number of cases（percentage）describes the grade data,and the Mann-Whitney U test compares groups.To further screen the variables in univariate analysis,multivariate logistic regression analysis was done on the variables with a p-value<0.05.The two-sided test was used for all statistical tests.The tested difference is considered statistically significant if p<0.05.Results:1.Clinical characteristics of AECOPD patients complicated by type Ⅱrespiratory failure and treated with NIPPV on admission and at dischargeA total of 196 eligible patients with the mean age of（72.3±9.3）years were recruited,involving 66.84%of males.75.00%of recruited patients had the education level of primary school,and 60.71%of them were from rural areas.56.63%of patients had a history of smoking,and 88.26%of them suffered comorbidities.77.55%of patients presented a longer than 10 years of disease course,and 99.49%had at least one episode of acute exacerbation within a year.The incidence of nutritional risk was 72.96%（143/196）.Symptoms on admission were severe,with the median CAT scores of 27（21,30）points.75.51%of patients had severe dyspnea with the mMRC scores of 4 points.Compared with those on admission,PaO₂,PaCO₂,SaO₂,pH,HR and RR at discharge were significantly improved（all P<0.05）.The median LOS was 10（8,13）days,and 115（58.67%）patients were hospitalized for less than 10 days,and 81（41.33%）were hospitalized for longer than 10 days.The median duration of NIPPV was 72（41.5,127.8）h,and the median hospitalization expense was 12210.41（9490.4,16598.8）yuan.2.Influencing factors for nutritional risks and clinical characteristics on admission of AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPVBased on the presence of nutritional risks,a total of 196 AECOPD patients complicated by type Ⅱ respiratory failure and treated withNIPPV were classified into nutritional risk group and non-nutritional risk group.Significant differences in the age,BMI,ALB,PAB,LYM%,ALC and grip strength were detected between groups（all P<0.05）.The multivariable logistic regression analysis revealed that BMI,ALB and LYM%were influencing factors for nutritional risks of AECOPD complicated by type Ⅱ respiratory failure and treated with NIPPV（all P<0.05）.3.Influencing factors for LOS and clinical characteristics on admission and at discharge of AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPVBased on the median LOS of 10（8,13）days,a total of 196 AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPV were classified into LOS≤10 days group and LOS>10 days group.Significant differences in the disease course,BMI,ALB,PAB and duration of NIPPV were detected between groups（all P<0.05）.The multivariable logistic regression analysis revealed that PAB and duration of NIPPV were influencing factors for LOS of AECOPD complicated by type Ⅱ respiratory failure and treated with NIPPV（both P<0.05）.Conclusions:1.AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPV are featured by the old age,long disease course and low education level.They are prone to suffer an acute exacerbation and high nutritional risk.The length of stay of these patients is about 10 days,with a long duration of NIPPV and high hospitalization expense.2.BMI,ALB and LYM%are considered as main indicators of nutrional risks in AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPV.Nutrition education for these patients and their families should be concerned.The nutrition diagnosis of the population with nutritional risks and the individualized nutrition support scheme are conductive to improve the prognosis.3.PAB and duration of NIPPV are the main influencing factors for LOS of AECOPD patients complicated by type Ⅱ respiratory failure and treated with NIPPV.The medical staff should actively improve the PAB level of patients and take comprehensive intervention measures to improve respiratory function,so as to reduce the patients’ dependence on NIPPV and shorten the length of stay.