炎症反应与COPD伴呼吸衰竭住院患者短期再入院的关系OACSTPCD

Objective To analyze the relationship between inflammatory reaction and the short-term readmission of hospitalized patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods Ninety-one hospitalized patients with COPD complicated with respiratory failure were included in this prospective cohort study.They were divided into the occurrence group(n=17)and the non-occurrence group(n=74)according to the occurrence of complications during hospitalization.They were also divided into the readmission group(n=18)and the non-readmission group(n=73)according to the 30-d readmission situation.Another 91 patients with COPD alone were assigned into the control group.The pre-treatment inflammation indicators(white blood cell(WBC),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α))were compared between patients with COPD alone and COPD complicated with respiratory failure and different prognosis.The risk factors of 30-d readmission of COPD complicated with respiratory failure were identified by multivariate binary Logistic regression analysis.The receiver operating characteristic(ROC)curve was delineated to analyze the diagnostic values of these risk factors for the short-term readmission of COPD patients complicated with respiratory failure.Results After treatment,the levels of WBC,CRP,and TNF-α in COPD patients with respiratory failure and simple COPD were significantly lower than those before treatment(all P<0.05).The levels of WBC,CRP and TNF-α in patients with COPD complicated with respiratory failure before treatment were significantly higher than those in patients with COPD alone(all P<0.05).The levels of WBC,CRP and TNF-α in COPD patients complicated with type Ⅱ respiratory failure before treatment were significantly higher than those in patients complicated with type Ⅰ respiratory failure(all P<0.05).The levels of CRP and TNF-α in the occurrence group before treatment were significantly higher than those in the non-occurrence group(both P<0.05).The levels of CRP and TNF-α in the readmission group before treatment were significantly higher than those in the non-readmission group(both P<0.05).Multivariate binary logistic regression analysis showed that there was no significant correlation between CRP and TNF-α levels and the 30-d readmission of COPD patients after adjusting for confounding factors(both P>0.05).However,regardless of the adjustment for confounding factors,CRP and TNF-α levels were significant factors affecting the 30-d readmission of COPD patients with respiratory failure(both P<0.05).The area under the ROC curve(AUC)of CRP,TNF-α and two combined before treatment for predicting 30-d readmission of COPD patients complicated with respiratory failure all exceeded 0.70,which had certain predictive value.Conclusions CRP and TNF-α yield high efficiency in predicting the short-term readmission of COPD patients complicated with respiratory failure.Treatment plans can be formulated according to CRP and TNF-α levels to reduce the risk of readmission.