优化循环生物标志物组合作为 COPD 急性加重期合并心力衰竭患者预后的预测指标。

Optimized combination of circulating biomarkers as predictors of prognosis in AECOPD patients complicated with Heart Failure.

机构信息

Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China.

Key Laboratory of Shenzhen Respiratory Diseases, Institute of Shenzhen Respiratory Diseases, Emergency Department, Shenzhen People's Hospital (The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China.

出版信息

Int J Med Sci. 2021 Feb 4;18(7):1592-1599. doi: 10.7150/ijms.52405. eCollection 2021.

DOI:10.7150/ijms.52405

PMID:33746575

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7976571/

Abstract

Systematic inflammation, nutritional status, and cardiovascular function have been associated with the outcomes of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with heart failure (HF). However, the value of their relevant biomarkers in predicting mortality has not been well defined yet. We aimed to investigate the prognostic value of circulating biomarkers including C-reaction protein (CRP)/albumin (ALB), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and N-terminal pro-brain natriuretic peptide (NT-proBNP) for AECOPD patients with HF. A retrospective study was carried out in the Second Clinical College of Jinan University from January 1, 2013 to January 31, 2019. A total of 146 cases of AECOPD complicated with HF were enrolled and classified into survivor group (n=94) and non-survivor group (n=52). The baseline characteristics, CRP/ALB ratio, NLR, PLR, serum levels of NT-proBNP, and other indicators were collected. The predictors for prognosis were analyzed by multivariate logistic regression, and the ability to predict 28-day mortality was evaluated by receiver operating characteristics curve (ROC) and the area under the curve (AUC). The patients in non-survivors had significantly higher levels of CRP, CRP/ALB, NLR, PCT and NT-proBNP, but lower ALB levels compared to the survivors [111.7 (56.9, 186.5) VS. 43.8 (10.3, 96.1) mg/L, 4.6 (2.0, 8.0) VS. 1.4 (0.3, 3.4), 22.2 (11.1, 40.1) VS. 12.0 (6.2, 24.8), 2.6 (0.2, 10.3) VS. 0.08 (0.1, 0.5) ng/ml, 17912.5 (9344.0, 34344.5) VS. 9809.0 (4415.9, 16387.2) ng/ml, 25.8 (23.2, 30.5) VS. 30.7 (27.9, 34.1) g/L; < 0.001, <0.001, 0.001, <0.001, <0.001, and < 0.001, respectively]. No significant difference in PLR was found between the two groups (=0.413). The logistic analysis revealed that CRP/ALB (OR=1.303, 95%CI: 1.145-1.483, <0.001), NT-proBNP (OR=1.041, 95%CI: 1.010-1.073, =0.009) and NLR (OR=1.010, 95%CI: 0.999-1.022, <0.001) are independent risk factors for predicting the 28-day mortality. The AUC of the ROC curves were 0.768, 0.767, 0.757, 0.723, 0.716, and 0.668 for CRP/ALB, PCT, CRP, NT-proBNP, ALB, and NLR, respectively. The combination of CRP/ALB, NLR and NT-proBNP as biomarkers was shown to have better accuracy for predicting prognosis (AUC=0.830, 95%CI: 0.761-0.899, <0.001), with a higher specificity of 80.8% and specificity of 77.7% as compared with each single biomarkers. High levels of NLR, CRP/ALB and NT-proBNP may be clinical usefully predictors for death in AECOPD patients with HF. Combination of NLR with CRP/ALB and NT-proBNP can provide a higher accuracy for predicting 28-day mortality in these patients.

摘要

系统性炎症、营养状况和心血管功能与慢性阻塞性肺疾病（COPD）急性加重（AECOPD）合并心力衰竭（HF）患者的结局相关。然而，其相关生物标志物在预测死亡率方面的价值尚未得到很好的定义。我们旨在研究循环生物标志物包括 C 反应蛋白（CRP）/白蛋白（ALB）、中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和 N 末端脑钠肽前体（NT-proBNP）对 AECOPD 合并 HF 患者预后的预测价值。

本研究为回顾性研究，于 2013 年 1 月 1 日至 2019 年 1 月 31 日在暨南大学第二临床学院进行。共纳入 146 例 AECOPD 合并 HF 的患者，并将其分为存活组（n=94）和非存活组（n=52）。收集了患者的基线特征、CRP/ALB 比值、NLR、PLR、血清 NT-proBNP 水平及其他指标。采用多因素 logistic 回归分析预测预后的影响因素，并通过受试者工作特征曲线（ROC）和曲线下面积（AUC）评估 28 天死亡率的预测能力。

与存活组相比，非存活组患者的 CRP、CRP/ALB、NLR、PCT 和 NT-proBNP 水平显著升高，而 ALB 水平显著降低[111.7（56.9，186.5）VS. 43.8（10.3，96.1）mg/L，4.6（2.0，8.0）VS. 1.4（0.3，3.4），22.2（11.1，40.1）VS. 12.0（6.2，24.8），2.6（0.2，10.3）VS. 0.08（0.1，0.5）ng/ml，17912.5（9344.0，34344.5）VS. 9809.0（4415.9，16387.2）ng/ml；均<0.001]。两组间 PLR 无显著差异（=0.413）。logistic 分析显示，CRP/ALB（OR=1.303，95%CI：1.145-1.483，<0.001）、NT-proBNP（OR=1.041，95%CI：1.010-1.073，=0.009）和 NLR（OR=1.010，95%CI：0.999-1.022，<0.001）是预测 28 天死亡率的独立危险因素。ROC 曲线的 AUC 分别为 CRP/ALB、PCT、CRP、NT-proBNP、ALB 和 NLR 的 0.768、0.767、0.757、0.723、0.716 和 0.668。CRP/ALB、NLR 和 NT-proBNP 联合作为生物标志物预测预后的准确性更高（AUC=0.830，95%CI：0.761-0.899，<0.001），特异性为 80.8%，敏感性为 77.7%，均高于各单个生物标志物。高 NLR、CRP/ALB 和 NT-proBNP 水平可能是 AECOPD 合并 HF 患者死亡的有临床意义的预测因子。NLR 与 CRP/ALB 和 NT-proBNP 的联合可提高这些患者 28 天死亡率的预测准确性。