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

参考文献

[1] Naseem S, Hassan M, Akhtar S N, et al. Effectiveness of roflumilast in treating chronic obstructive pulmonary disease: a systematic review and meta—analysis[J]. Cureus, 2022, 14(3): e22843.

[2] 张天薇, 李梦夏, 范习康, 等 . 慢性阻塞性肺疾病加重的流行病学研究进展[J]. 现代预防医学, 2025, 52(13): 2343-2348.

[3] Zhang T W, Li M X, Fan X K, et al. Epidemiological research progress on the aggravation of chronic obstructive pulmonary disease[J]. Mod Prev Med, 2025, 52(13): 2343-2348.

[4] Lopez—Campos J L, Agustí A . Heterogeneity of chronic obstructive pulmonary disease exacerbations: a two—axes classification proposal[J]. Lancet Respir Med, 2015, 3(9): 729-734.

[5] Wang Y, Liu N, Zhang Z . Respiratory electrophysiologic studies in chronic obstructive pulmonarydisease[J]. Medicine(Baltimore), 2019, 98(1): e13993.

[6] Luo F, Li Y, Zhao Y, et al. Systemic immune—inflammation index predicts the outcome after aneurysmal subarachnoid hemorrhage[J]. Neurosurg Rev, 2022, 45(2): 1607-1615.

[7] Qi W X, Xiang Y, Zhao S, et al. Assessment of systematic inflammatory and nutritional indexes in extensive—stage small—cell lung cancer treated with first—line chemotherapy and atezolizumab[J]. Cancer Immunol Immunother, 2021, 70(11): 3199-3206.

[8] Wang R H, Wen W X, Jiang Z P, et al. The clinical value of neutrophil—to—lymphocyte ratio (NLR), systemic immune—inflammation index (SII), platelet—to—lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage[J]. Front Immunol, 2023, 14: 1115031.

[9] Leuzzi G, Galeone C, Taverna F, et al. C—reactive protein level predicts mortality in COPD: a systematic review and meta—analysis[J]. Eur Respir Rev, 2017, 26(143): 160070.

[10] Shen S, Xiao Y . Association between C—reactive protein and albumin ratios and risk of mortality in patients with chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2023, 18: 2289-2303.

[11] Skolasinski S D, Panoskaltsis—Mortari A . Lungtissue bioengineering for chronic obstructive pulmonary disease:overcoming the need for lung transplantation from human donors[J]. Expert Rev Respir Med, 2019, 13(7): 665-678.

[12] Luo B Y, Yang Y, Duan Y F, et al. Preoperative C—reactive protein/albumin ratio predicts the prognosis of patients with resectable pancreatic cancer[J]. Zhonghua Wai Ke Za Zhi, 2018, 56(9): 712-717.

[13] Guo S, He X, Chen Q, et al. The C—reactive protein/albumin ratio, a validated prognostic score, predicts outcome of surgical renal cell carcinoma patients[J]. BMC Cancer, 2017, 17(1): 171.

[14] Komura N, Mabuchi S, Shimura K, et al. Significance ofpretreatment C—reactive protein, albumin, and C—reactive protein to albumin ratio in predicting poor prognosis in epithelial ovarian cancer patients[J]. Nutr Cancer, 2021, 73(8): 1357-1364.

[15] Yu J, Park J Y, Ha S, et al. C—reactive protein/albumin ratio and acute kidney injury after radical cystectomy among elderly patients: a propensity score—matched analysis[J]. Dis Markers, 2020, 2020: 8818445.

[16] Sonsöz M R, Karadamar N, Yılmaz H Ç, et al. C—reactive protein to albumin ratio predicts in—hospital mortality in patients with acute heart failure[J]. Turk Kardiyol Dern Ars, 2023, 51(3): 174-181.

[17] Matsuoka H, Ando K, Hu Q, et al. Postoperative C—reactive protein/albumin ratio is a biomarker of risk of recurrence and need for adjuvant chemotherapy for stageⅢ colorectal cancer[J]. Int J Clin Oncol, 2020, 25(7): 1318-1326.

[18] Mangalesh S, Dudani S, Mahesh N K . Development of a novel inflammatory index to predict coronary artery disease severity in patients with acute coronary syndrome[J]. Angiology, 2024, 75(3): 231-239.

[19] Bruzzaniti S, Bocchino M, Santopaolo M, et al. An immunometabolic pathomechanism for chronic obstructive pulmonary disease[J]. Proc Natl Acad Sci U S A, 2019, 116(31): 15625-15634.

[20] Ling Y, Wang J, Wang L, et al. Roles of CEACAM1 in cell communication and signaling of lung cancer and other diseases[J]. Cancer Metastasis Rev, 2015, 34(2): 347-357.

[21] Li Y J, Pan C Z, Fang C Q, et al. Pneumonia caused by extensive drug—resistant Acinetobacter baumannii among hospitalized patients: genetic relationships, risk factors and mortality[J]. BMC Infect Dis, 2017, 17(1): 371.

[22] Dong Y, Zhou X, Zhang Y, et al. Applicationvalue of blood heparin—binding protein in the diagnosis of acute exacerbation of chronic obstructive pulmonary disease[J]. Contrast Media Mol Imaging, 2021, 2021: 3800211.

[23] Yang H, Long F, Zhang Y, et al. 1α,25—Dihydroxyvitamin D3 induces neutrophil apoptosis through the p38 MAPK signaling pathway in chronic obstructive pulmonary disease patients[J]. PLoS One, 2015, 10(4): e0120515.

基金资助

^*辽宁省自然科学基金项目(2021-MS-380)