全身免疫炎症指数、C反应蛋白/白蛋白比值预测老年慢性阻塞性肺疾病急性加重合并Ⅱ型呼吸衰竭预后价值^*

The prognostic value of systemic immune inflammation index and C-reactive protein/albumin ratio in predicting acute exacerbation of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure in the elderly

摘要

目的 探讨全身免疫炎症指数 (SII)、C反应蛋白 (CRP) / 白蛋白 (Alb) 比值对老年慢性阻塞性肺疾病 (COPD) 急性加重合并Ⅱ型呼吸衰竭预后的预测价值。方法 选取2019年3月—2024年3月在锦州市中心医院收治的196例COPD急性加重合并Ⅱ型呼吸衰竭老年患者作为研究对象, 根据患者28 d后预后情况分为死亡组 (24例) 和存活组 (172例), 计算SII、CRP/Alb比值, 采用logistic多因素分析老年COPD急性加重合并Ⅱ型呼吸衰竭预后的影响因素, 采用ROC曲线分析SII、CRP/Alb比值对老年COPD急性加重合并Ⅱ型呼吸衰竭预后的预测价值。结果 两组急性生理和慢性健康评估Ⅱ (APACHE Ⅱ) 评分、白细胞 (WBC) 计数、淋巴细胞 (LY) 计数、SII、Alb、CRP、CRP/Alb比值比较, 差异均具有统计学意义 (P<0.05); logistic多因素分析显示APACHE Ⅱ评分、WBC计数、SII、CRP、CRP/Alb比值均为患者死亡的危险因素 (P<0.05), LY计数、Alb均为患者死亡的保护因素 (P<0.05); ROC曲线分析显示SII、CRP/Alb比值联合预测患者预后价值中AUC为0.862 (95%CI: 0.778~0.946), 灵敏度为0.792, 特异度为0.826。结论 SII、CRP/Alb比值在老年COPD急性加重合并Ⅱ型呼吸衰竭的预后预测中具有较高的价值和准确性, 可以作为评估患者预后的重要指标。

Abstract

Objective To investigate the prognostic value of systemic immune-inflammation index (SII) and CRP/Alb ratio in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure. Methods Clinical data of 196 elderly patients with acute exacerbation of COPD combined with type II respiratory failure admitted to Jinzhou Central Hospital from March 2019 to March 2024 were selected, and the patients were divided into death group (n=24) and survival group (n=172) according to their prognosis after 28 days. SII and CRP/Alb ratio were calculated. Logistic multivariate analysis of prognostic factors of acute exacerbation of COPD combined with type Ⅱ respiratory failure in elderly patients. ROC curve analysis of the prognostic value of SII combined with CRP/Alb ratio in acute exacerbation of COPD combined with type II respiratory failure. Results There were statistically significant differences in acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, white blood cell (WBC) count, lymphocyte (LY) count, SII, Alb, CRP, and CRP/Alb ratio between the two groups (P<0.05). logistic multivariate analysis showed that APACHE Ⅱ score, WBC, SII, CRP, and CRP/Alb ratio were all risk factors for death in patients (P<0.05), while LY count and Alb were protective factors for death in patients (P<0.05). ROC curve analysis showed that the AUC of SII and CRP/Alb ratio in predicting the prognostic value of patients was 0.862 (95%CI: 0.778~0.946), the sensitivity was 0.792, and the specificity was 0.826. Conclusion The combined detection of SII and CRP/Alb ratio has high value and accuracy in predicting the prognosis of elderly patients with acute exacerbation of COPD complicated with type Ⅱ respiratory failure, and can be used as an important indicator to evaluate the prognosis of patients.

关键词

慢性阻塞性肺疾病 / Ⅱ型呼吸衰竭 / 全身免疫炎症指数 / C反应蛋白 / 白蛋白

Key words

Chronic obstructive pulmonary disease / Type Ⅱ respiratory failure / Systemic immune inflammatory index / C-reactive protein / Albumin

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基金资助

^*辽宁省自然科学基金项目(2021-MS-380)