Study On The Influencing Factors Of 3-year Survival In Elderly Hospitalized Patients With AECOP

Objective:Chronic obstructive pulmonary disease(COPD)is a disease with high incidence rate and mortality,which seriously threatens human health.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is the main cause of hospitalization and death in patients with COPD.Exploring the prognostic factors of acute exacerbation of chronic obstructive pulmonary disease(COPD)patients will help optimize treatment strategies and standardize disease management.The long-term survival rate of elderly hospitalized patients with AECOPD is relatively low,and there is currently a lack of clinical research on the influencing factors of traditional Chinese and Western medicine on the long-term survival of elderly hospitalized patients with AECOPD.Methods:Our study is a cross-sectional study.We retrospectively collected the clinical data of the elderly AECOPD inpatients in the respiratory department of Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1,2013 to September 30,2019,included 664 elderly AECOPD inpatients,investigated the 3-year survival and treatment of the patients included in the study,and analyzed the factors affecting the 3-year survival of the patients.Results:The 3-year all-cause mortality rate of elderly hospitalized patients with AECOPD is 20.48%.In terms of long-term drug treatment,the proportion of patients who adhere to regular use of inhaled bronchodilators is 48.80%,and the proportion of patients who adhere to regular use of traditional Chinese medicine treatment is 16.72%.The patients were divided into a survival group(528 cases)and a death group(136 cases)based on their 3-year survival status,and the two groups were compared.In general,compared to the survival group,patients in the death group were older(80.73%vs 76.35%,P<0.001),had a history of smoking(68.38%vs 55.87%,P<0.01),had a lower body mass index(21.32%vs 41.67%,P<0.001),had a higher frequency of acute exacerbations ≥2 times in the past year(24.26%vs 14.96%,P<0.05),and had longer hospital stays(13 days vs 10 days,P<0.001).In terms of complications,compared with the survival group,the death group had a higher complication index(1.46 vs 1.06,P<0.001).The death group had Respiratory failure(27.94%vs 9.28%,P<0.001),pulmonary heart disease(34.56%vs 14.20%,P<0.001),cardiac insufficiency(52.94%vs 28.03%,P<0.001),arrhythmia(30.88%vs 18.75%,P<0.01),Hypoalbuminemia(21.32%vs 6.44%,P<0.001)The proportion of benign prostatic hyperplasia(30.15%vs 21.02%,P<0.05),fungal infection(13.24%vs 6.06%,P<0.01),chronic renal insufficiency(14.71%vs 4.73%,P<0.01),anemia(27.94%vs 15.53%,P<0.01)is higher,and the proportion of concurrent bronchial asthma(15.44%vs 23.48%,P<0.05)is lower.In terms of auxiliary examination,484 patients underwent pulmonary function examination.Compared with the survival group,the forced Vital capacity/predicted value(%)(P<0.001)in the death group was lower,and the forced expiratory volume in the first second was lower(P<0.05).Compared to the survival group,the red blood cell count in the death group(4.105×1012/L vs 4.3×1012/L,P<0.05),hemoglobin content(126.0g/L vs 131.0g/L,P<0.05),arterial blood pH(7.414 vs 7.427,P<0.01),arterial blood oxygen saturation(95.35%vs 95.85%,P<0.05)were lower,C-reactive protein(29.59mg/L vs 13.51mg/L,P<0.001),arterial blood carbon dioxide partial pressure(40.8mmHg vs 37.7mmHg,P<0.05),and brain natriuretic peptide(209.0pg/mL vs 54.0pg/mL,P<0.001)were higher.In terms of treatment during hospitalization,patients in the death group received positive pressure mechanical ventilation(20.59%vs 5.49%,P<0.001),hormone treatment(19.12%vs 8.52%,P<0.001),and antifungal drug treatment(13.24%vs 6.06%,P<0.01)at a higher rate.In terms of traditional Chinese medicine syndrome differentiation,the proportion of heat syndrome elements(46.32%vs 58.14%)in the death group is lower,while the proportion of kidney syndrome elements(27.21%vs 16.29%),stasis syndrome elements(38.97%vs 26.33%),and edema syndrome elements(38.97%vs 13.26%)is higher.After Cox risk proportional regression model analysis,the independent risk factors for 3year all-cause mortality in elderly hospitalized AECOPD patients included older age(HR:1.0707,95%CI:1.0400-1.1023,P<0.001),smoking history(HR:1.7876,95%CI:1.17332.7234,P<0.01),Charlson Comorbidity index(HR:1.2091,95%CI:1.0288-1.4209,P<0.05),arterial oxygen pressure(HR:1.0137,95%CI:1.0060-1.0215,P<0.001)BNP(HR:1.0006,95%CI:1.0001-1.0011,P<0.001),pulmonary heart disease(HR:1.8955,95%CI:1.2354-2.9083,P<0.01),accompanied by Respiratory failure(HR:2.4374,95%CI:1.3782-4.3107,P<0.01),TCM syndrome elements include disease location element kidney(HR:1.6387,95%CI:1.0546-2.5461,P<0.05),disease element edema(HR:2.5118,95%CI:1.6533-3.8162,P<0.001).Regular use of bronchodilators(HR:0.4743,95%CI:0.3238-0.6948,P<0.001)is an independent protective factor.The 3-year survival rate of elderly hospitalized patients with AECOPD is 79.52%,and the prognosis is poor.Older age,smoking history,pulmonary heart disease,Respiratory failure,lower arterial partial pressure of oxygen,higher BNP,TCM syndrome differentiation elements including kidney and edema are independent risk factors for 3-year all-cause death of elderly hospitalized patients with AECOPD.Long term regular use of Bronchiectasis is an independent protective factor for 3-year all-cause death.Summary:The 3-year survival rate of elderly hospitalized patients with AECOPD is relatively low.Old age,smoking history,pulmonary heart disease,respiratory failure,low arterial partial pressure of oxygen,high BNP,TCM syndrome differentiation elements including kidney and edema are independent risk factors for all-cause death of elderly AECOPD patients in 5 years.Long term regular use of bronchodilators is an independent protective factor for 3-year allcause mortality.