Changes Of Systemic Immune Inflammation Index,Red Blood Cell Distribution Width And D-Dimer In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease With Pulmonary Embolism And Their Clinlical Significance

Objective:Retrospective analysis was conducted to explore the changes and clinical significance of systemic immune inflammatory index（SII）,erythrocyte distribution width（RDW）and D-dimer in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）complicated with pulmonary embolism（PE）.Methods:Seventy-one patients with AECOPD combined with PE admitted to the Emergency Department and respiratory Department of the First Affiliated Hospital of Dali University from December 2021 to December 2022 were randomly selected as the combined group.The combined group was then divided into low-risk group,middle-risk group and high-risk group according to the risk stratification of pulmonary embolism in the Guidelines for Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism^[1]formulated in 2018.Eighty-four patients with simple AECOPD were in COPD group,and seventy-five patients with simple PE were in pulmonary embolism group.The gender,age,D-dimer,B-type natriuretic peptide（BNP）,white blood cell count（WBC）,neutrophil count（New）,standard deviation of red blood cell distribution width（RDW-SD）,hemoglobin（Hb）,lymphocyte count（Lym）,platelet count（PLT）,oxygen partial pressure（PO₂）,carbon dioxide partial pressure（PCO₂）,and whether there was smoking,hypertension,diabetes and other diseases were recorted respectively,and then calculated the systemic immune inflammation index（SII）.Statistical software was used to retrospectively analyze the differences in the above data of the three groups of patients,and the correlation between SII,RDW-SD,D-dimer and AECOPD combined with PE was evaluated by multivariate correlation analysis.The diagnostic value of SII,RDW-SD,D-dimer and their combined detection on AECOPD and PE was further discussed by ROC curve.Results:（1）There were no significant differences in baseline data（age,gender）and the presence of hypertension,diabetes and other diseases among the three groups,but there were differences in the distribution of smoking:there were differences between the COPD group and the combined group and the pulmonary embolism group,and there were no significant differences between the combined group and the pulmonary embolism group.（2）The levels of D-dimer,SII,RDW-SD,WBC and New in the combined group and pulmonary embolism group were higher than those in the COPD group;PO2 levels in the combined group and pulmonary embolism group were significantly lower than those in the COPD group;PCO2 and Hb levels in the COPD group were higher than those in the combined group and pulmonary embolism group;BNP levels in the combined group were higher than those in the pulmonary embolism group.The above differences were statistically significant（P<0.05）.（3）There were no significant differences in D-dimer,SII,RDW-SD,WBC,PO₂,PCO₂,New and Hb levels between the combined group and the pulmonary embolism group.There were no significant differences in RDW-SD,WBC,BNP levels between the COPD group and the pulmonary embolism group and the BNP levels between the COPD group and the combined group.（4）The effects of SII,RDW-SD and D-dimer on AECOPD combined with PE were statistically significant:SII was the promoting factor of AECOPD combined with PE（OR=1.003,95%CI:1.001,1.006,P<0.01）;RDW-SD was the promoting factor of AECOPD combined with PE（OR=1.153,95%CI:1.037,1.281,P<0.01）.D-dimer was also a promoter of AECOPD with PE（OR=1.001,95%CI:1.001,1.004,P<0.01）.（5）SII,RDW-SD and D-dimer had statistically significant effects on the combination of AECOPD and PE:They were all promoting factors for the combination of AECOPD and PE.（6）The levels of SII and D-dimer in high-risk and medium-risk groups of AECOPD patients with PE were significantly higher than those in low-risk group,while those in high-risk group were higher than those in medium-risk group;RDW-SD level in high-risk group was significantly higher than that in low-risk group,with statistical significance（P<0.05）.There was no significant difference in RDW-SD level between high-risk group and medium-risk group,and between medium-risk group and low-risk group.（7）ROC curve predicted AECOPD combined with PE:AUC under SII curve=0.748（sensitivity was 80.3%,specificity was 57.1%）;Area AUC under RDW-SD curve=0.731（sensitivity 69.0%,specificity 64.3%）;Area AUC under D-dimer curve=0.850（sensitivity 78.9%,specificity 84.5%）;The AUC of SII,RDW-SD and D-dimer was0.905（sensitivity was 80.3%,specificity was 89.3%）.Conclusion:The levels of SII,RDW-SD and D-dimer in AECOPD patients with PE were significantly increased,and the two indexes of SII and D-dimer could be used to assess the risk stratification of pulmonary embolism.The combined detection of the three indexes is of great significance for the diagnosis of AECOPD patients with PE,and can be used as laboratory indexes for early diagnosis,providing new ideas for diagnosis.