| Citation: |
SU Yan, GAO Hui, ZHANG Yan, YU Siyong. Value of serological indicators combined with Acute Physiology and Chronic Health Evaluation Ⅱ score in predicting prognosis of acute exacerbation of chronic obstructive pulmonary disease[J]. Journal of Clinical Medicine in Practice, 2023, 27(17): 82-87. DOI: 10.7619/jcmp.20231448
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To investigate the value of serological indicators combined with Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
A total of 359 patients with AECOPD were prospectively selected as study subjects, and were divided into good prognosis group(n=190) and poor prognosis group (n=169) according to the 6-month follow-up after discharge. Serological indicators[platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), red blood cell volume distribution width (RDW), neutrophil to monocyte product (NMP)], and APACHE Ⅱ score were recorded to screen influencing factors related to the prognosis of AECOPD patients, and a prognostic early warning model was constructed. The model was converted into a simple scoring tool (Poor Prognosis Rating Scale for AECOPD patients). Receiver Operating Characteristic (ROC) curves were plotted for prospective validation.
Multivariate Logistic regression analysis showed that APACHE Ⅱ score, PLR, NLR, RDW and NMP were high risk factors for poor prognosis in patients with AECOPD (OR=22.651, 16.042, 12.599, 17.669, 11.289; P < 0.05); based on APACHEⅡ score, PLR, NLR, RDW and NMP, a nomogram warning model was constructed to predict individual patient risk score. The incidence of adverse prognosis in high-risk patients was 60.00% (96/160), which was higher than 36.68%(73/199) in low-risk patients, and the difference was statistically significant (χ2=18.292, P < 0.001). Prospective validation showed that the area under the curve (AUC) for predicting poor prognosis in AECOPD patients by Poor Prognosis Rating Scale was 0.902 (95%CI, 0.899 to 1.000), with sensitivities and specificities of 85.18% and 93.93%, respectively.
The prognostic warning model and scoring criteria for AECOPD patients based on APACHEⅡscore, PLR, NLR, RDW and NMP can help clinicians effectively identify high-risk groups with poor prognosis and formulate reasonable diagnosis and treatment measures to improve the prognosis of patients.
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