Zeng Jiaxin, Feng Jiaming, Luo Yuanming, Wei Hailong, Ge Huiqing, Liu Huiguo, Zhang Jianchu, Li Xianhua, Pan Pinhua, Xie XiuFang, Yi Mengqiu, Cheng Lina, Zhou Hui, Zhang Jiarui, Peng Lige, Pu Jiaqi, Chen Xueqing, Yi Qun, Zhou Haixia
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University.
West China School of Medicine, West China Hospital, Sichuan University.
J Atheroscler Thromb. 2025 Apr 1;32(4):439-457. doi: 10.5551/jat.65177. Epub 2024 Oct 30.
Venous thromboembolism (VTE) risk significantly increases in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD), which is characterized by an enhanced inflammatory response. This study aimed to evaluate the predictive value of inflammatory biomarkers for VTE in AECOPD.
A prospective, multicenter study was conducted to include patients hospitalized for AECOPD. Inflammatory biomarkers on admission were compared between the patients who developed VTE during hospitalization and the patients without VTE. A logistic regression analysis was used to identify inflammatory biomarkers with an independently predictive value.
Among the 13,531 AECOPD inpatients, 405 (2.99%) developed VTE during hospitalization. Patients who developed VTE had higher levels of inflammatory biomarkers, including the white blood cell count, neutrophil percentage, systemic immune/inflammatory index, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH), and lower lymphocyte and eosinophil ratios (ESOR), platelet, and albumin (p all ＜0.05). NLR, LDH, CRP, PCT, and ESOR were identified as independent predictors of VTE (odds ratios (ORs) were 2.22, 1.95, 1.64, 1.59, and 1.37, respectively). The incidence of VTE increased with increasing NLR, LDH, CRP, and PCT quartiles, and a decreasing ESOR quartile. Among them, NLR and LDH had predictive capabilities for VTE that were comparable to the widely used Padua and IMPROVE scores.
Easily available inflammatory parameters, such as NLR and LDH, can identify AECOPD patients at increased risk for VTE who may therefore be candidates for thromboprophylaxis.
慢性阻塞性肺疾病急性加重期（AECOPD）患者静脉血栓栓塞症（VTE）风险显著增加，其特征为炎症反应增强。本研究旨在评估炎症生物标志物对AECOPD患者VTE的预测价值。
开展一项前瞻性多中心研究，纳入因AECOPD住院的患者。比较住院期间发生VTE的患者与未发生VTE的患者入院时的炎症生物标志物。采用逻辑回归分析确定具有独立预测价值的炎症生物标志物。
在13531例AECOPD住院患者中，405例（2.99%）在住院期间发生VTE。发生VTE的患者炎症生物标志物水平较高，包括白细胞计数、中性粒细胞百分比、全身免疫/炎症指数、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、C反应蛋白（CRP）、降钙素原（PCT）和乳酸脱氢酶（LDH），而淋巴细胞和嗜酸性粒细胞比值（ESOR）、血小板和白蛋白水平较低（所有p均＜0.05）。NLR、LDH、CRP、PCT和ESOR被确定为VTE的独立预测因子（比值比（OR）分别为‚2.22、1.95、1.64、1.59和1.37）。VTE的发生率随NLR、LDH、CRP和PCT四分位数的增加以及ESOR四分位数的降低而增加。其中，NLR和LDH对VTE的预测能力与广泛使用的帕多瓦和IMPROVE评分相当。
易于获得的炎症参数，如NLR和LDH，可识别VTE风险增加的AECOPD患者，因此这些患者可能是血栓预防的候选对象。
