Clinical Significance Of RDW And NT-proBNP In Right Heart Failure Caused By COPD And Cor Pulmonale

Objective: To explore the relationship between RDW and NT-pro BNP and right heart failure caused by COPD and cor pulmonale,to provide a basis for clinicians to identify patients with right heart failure early,give appropriate treatment and monitoring,and reduce the fatality rate.Methods: During the period of April 2021-2 August 2022,respectively.The general data（age,gender,BMI）,clinical characteristics（hospitalization duration,edema）,laboratory tests（blood routine,CRP,NT-pro BNP,coagulation index,ALB,admission blood gas analysis）,and auxiliary examination.Divide into heart failure group and non heart failure group according to the presence or absence of right heart failure,right heart failure was further divided into grade II to IV.Results: 1.A total of105 study cases,including 60 males and 45 females,were included in this study.In the heart failure group,60 patients were 34 males and 26 females,with a mean age of 77.68 ±9.64 years;in the non-heart failure group,45 patients were 26 males and 19 females,with a mean age of 77.60± 9.31 years.General data analysis showed that the hospitalization time in the heart failure group was significantly longer than that in the non heart failure group（P<0.05）,and the proportion of bilateral lower limb edema was significantly higher than that in the non heart failure group（P<0.05）,and the difference between gender,age,duration and BMI were not significant（P> 0.05）.2.Differential analysis of laboratory test indicators between the two groups: RDW,N%,CRP,D-D,and NT-pro BNP in the heart failure group were significantly higher than those in the non heart failure group,with a statistically significant difference（P<0.05）.ALB and PaO₂ heart failure group was significantly lower than non heart failure group（P<0.05）.Pa CO2,RBC,HB,HCT,WBC,and FIB varied between the two groups,but did not reach a significant level（P> 0.05）.3.Analysis of the difference in cardiac ultrasound indicators between the two groups: The ultrasound indicators of RA,RV,and PASP in the heart failure group were significantly higher than those in the non heart failure group（P<0.05）,while the difference between the MPA groups was not significant（P>0.05）.4.Difference analysis of RDW and NT-pro BNP in different cardiac function grades of patients in heart failure group: RDW and NT-pro BNP in different cardiac function grades in heart failure group,among which patients in grade and grade were significantly higher than grade patients,and grade patients were significantly higher than grade patients.5.Correlation analysis between RDW,NT-pro BNP and each indicator: RDW showed significant positive correlation with NT-pro BNP（r=0.322,P=0.012）,with RV（r=0.372,P=0.003）and PASP（r=0.393,P=0.002）,CRP（r=0.458,P <0.001）,with PaO₂（r=-0.589,P <0.001）,NT-pro BNP with RA（r=0.520,P <0.001）and Pa CO2（r=0.289,P=0.025）and with Pa O 2（r=-0.456,P<0.001）.6.Analysis of risk factors for right heart failure caused by COPD and cor pulmonale（binary logistic regression analysis）: The results showed that RDW,NT-pro BNP,and RA were independent risk factors for heart failure.7.Ability of RDW and NT-pro BNP alone and combined to diagnose right heart failure caused by COPD and cor pulmonale: Through ROC curve analysis,the area under the curve of right heart failure caused by RDW alone was 0.714.When the threshold was 13.95,it had the highest diagnostic value,sensitivity of 60.0% and specificity of 77.8%.The area under the curve of NT-pro BNP to diagnose right heart failure due to COPD and cor pulmonale was 0.804,with the highest diagnostic value when the threshold was 498.5,the sensitivity was 78.3%and the specificity was 80.0%.The area under the curve for the combined diagnosis was0.809,the sensitivity was 73.3% and the specificity was 82.2%.Because the area under the curve of the combined diagnosis was similar to the area of NT-pro BNP alone,further analysis of NRI and NRI: 63.3%,95%CI: 0.274⁰.993,P <0.001;IDI: 7.0%,95%CI:0.022⁰.118,P=0.004,it was concluded that the combination of RDW and NT-pro BNP could significantly improve the diagnostic efficacy of right heart failure caused by COPD and pulmonary heart disease.Conclusion: 1.In COPD with right heart failure,patients usually increased RDW,NT-pro BNP,neutrophil percentage,CRP,D-D,RA,RV,PASP,and decreased ALB and PaO₂.2.RDW,NT-pro BNP,and RA are independent risk factors for right heart failure caused by COPD and cor pulmonale,and their values gradually increase as right heart function deteriorates,which can be used to determine the severity of right heart failure.3.The combination of RDW and NT-pro BNP has a higher diagnostic value than that alone in patients with right heart failure caused by COPD and cor pulmonale disease.