Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, China.
Health Science Center, Ningbo University, Ningbo, China.
Clin Exp Med. 2023 Dec;23(8):5161-5176. doi: 10.1007/s10238-023-01117-x. Epub 2023 Jun 16.
Autoimmunity is present in patients with stable chronic obstructive pulmonary disease (COPD), playing a role in indirect and direct ways. We aimed to explore whether autoimmunity could play a role in COPD exacerbations and construct autoimmunity-related prediction models. This prospective, longitudinal, observational cohort study enrolled 155 patients with acute COPD exacerbations (AECOPD) followed for at least two years. The laboratory parameters, including complete blood count, serum immunoglobulins G/A/M and complement C3/C4 levels, were collected at enrollment. We studied the demographic characteristics, clinical characteristics and laboratory parameters to identify independent risk factors and build predictive models. The results showed that lower lymphocyte count was associated with noninvasive ventilation (NIV) in patients with AECOPD (the odds ratio [OR] 0.25, the 95% confidence interval [CI]: 0.08-0.81, P = 0.02). Lymphocyte count performed well with an area under the curves (AUC) of 0.75 (P < 0.0001, sensitivity: 78.1%, specificity: 62.3%, cutoff value [Cov] ≤ 1.1). The C index, calibration plot, decision curve analysis (DCA) and bootstrap repetitions indicated that this clinical prediction model based on lymphocyte count for NIV in patients with AECOPD performed well. Having prior home oxygen therapy (OR: 2.82, 95% CI: 1.25-6.36, P = 0.013) and higher COPD Assessment Test (CAT) scores (OR: 1.14, 95% CI: 1.03-1.25, P = 0.011) were associated with the increased risk for respiratory failure. For predicting respiratory failure, CAT scores and home oxygen therapy combined had an AUC-ROC of 0.73 (P < 0.0001). This clinical prediction model based on lymphocyte count may help to assist in treatment decisions for NIV in patients with AECOPD. Lower complement C3 seems to be associated with worse outcomes in patients with AECOPD.
自身免疫存在于稳定期慢性阻塞性肺疾病（COPD）患者中，以间接和直接的方式发挥作用。我们旨在探讨自身免疫是否在 COPD 加重中发挥作用，并构建自身免疫相关预测模型。这项前瞻性、纵向、观察性队列研究纳入了 155 例急性 COPD 加重（AECOPD）患者，至少随访 2 年。在入组时收集了包括全血细胞计数、血清免疫球蛋白 G/A/M 和补体 C3/C4 水平在内的实验室参数。我们研究了人口统计学特征、临床特征和实验室参数，以确定独立的危险因素并构建预测模型。结果表明，AECOPD 患者淋巴细胞计数较低与无创通气（NIV）相关（比值比 [OR] 0.25，95%置信区间 [CI]：0.08-0.81，P = 0.02）。淋巴细胞计数的曲线下面积（AUC）为 0.75（P < 0.0001，灵敏度：78.1%，特异性：62.3%，截断值 [Cov] ≤ 1.1）。C 指数、校准图、决策曲线分析（DCA）和自举重复表明，基于 AECOPD 患者淋巴细胞计数的 NIV 临床预测模型表现良好。既往家庭氧疗（OR：2.82，95%CI：1.25-6.36，P = 0.013）和更高的 COPD 评估测试（CAT）评分（OR：1.14，95%CI：1.03-1.25，P = 0.011）与呼吸衰竭风险增加相关。对于预测呼吸衰竭，CAT 评分和家庭氧疗联合的 AUC-ROC 为 0.73（P < 0.0001）。基于淋巴细胞计数的这种临床预测模型可能有助于辅助 AECOPD 患者 NIV 的治疗决策。补体 C3 较低似乎与 AECOPD 患者的预后较差相关。
