ICU内慢性阻塞性肺疾病急性加重患者预后危险因素分析

目的筛选与ICU内AECOPD患者死亡相关的独立危险因素。方法这是一项回顾性病例对照研究,回顾性分析2016年1月1日-2019年5月30日入住广州医科大学附属第一医院ICU的AECOPD患者,根据出ICU时的转归分为存活组和死亡组。收集患者的人口学、临床资料、治疗转归。经多元Logistics回归分析患者死亡的独立危险因素,受试者操作特性(ROC)曲线分析独立危险因素对AECOPD患者死亡的预测价值。结果共纳入170例AECOPD患者,单因素分析发现高APACHEⅡ评分,高中性粒细胞比例、降钙素原、肌钙蛋白I、pro-BNP、乳酸、尿素氮浓度,低血清白蛋白和总蛋白水平以及合并脓毒症休克是AECOPD患者ICU内死亡的危险因素(P值均<0.05)。经Logistics回归分析,筛选出死亡的独立危险因素为高APACHEⅡ评分、合并脓毒症休克,OR值分别为1.13(95%CI 1.052~1.214)、5.092(95%CI 1.697~15.277),血清总蛋白水平是死亡的保护因素,OR值为0.879(95%CI 0.818~0.944)。ROC曲线显示联合APACHEⅡ评分、血清总蛋白水平、是否合并脓毒症休克三个指标的模型显示出对患者死亡有较高的预测价值,ROC曲线下面积(AUC)为0.848(95%CI 0.785~0.911;P<0.0001)。结论入住ICU的AECOPD患者有高APACHEⅡ评分,低总蛋白水平,合并脓毒症休克的预后较差。

Analysis of risk factors for prognosis of COPD patients with acute exacerbation in intensive care unit

Objective To screen the independent risk factors associated with death in patients with AECOPD in ICU.Methods This retrospective cohort study included patients from ICU at the First Affiliated Hospital of Guangzhou Medical University from January 1,2016 to May 30,2019.They were divided into the survival group and the death group according to the outcome when transferring out of ICU.Their demographics,clinical data,and treatment outcomes were collected.Multivariate logistic regression analysis was used to analyze the independent risk factors for prognosis.The predictive value of independent risk factors was investigated by receiver operator characteristic(ROC)curves.Results A total of 170 AECOPD patients were included in the study.Univariate analysis revealed that risk factors for AECOPD ICU-mortality included higher APACHEⅡscore,higher proportion of neutrophils,procalcitonin,troponin I,pro-BNP,lactate,blood urea nitrogen(BUN),lower level of serum albumin and serum total protein,and combined with septic shock(P<0.05).Multivaritae logistic regression showed three factors including higher APACHEⅡscore,combined with septic shock were independent death risk factorsOR values=1.13(95%CI 1.052-1.214),5.092(95%CI 1.697-15.277)respectively].Whereas serum total protein level was protective factor(OR=0.879,95%CI 0.818-0.944).The combined model using APACHE Ⅱ score,serum total protein level and combined with septic shock showed the best predictive ability,with an area under the ROC curve(AUC)of 0.848(95%CI 0.785-0.911,P<0.0001).Conclusion The AECOPD patients with higher APACHEⅡscore and lower serum total protein,and combined with septic shock have poor prognosis.