Li Li, Feng Qinsheng, Yang Chunsong
Department of Respiratory and Critical Care Medicine, Baise People's Hospital, Baise, Guangxi, 533099, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Nov 29;19:2587-2597. doi: 10.2147/COPD.S481483. eCollection 2024.
To explore the association of D-dimer-to-albumin ratio (DAR) with hospital readmission within one year in patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD).
From January 2019 to October 2022, 509 patients with COPD were enrolled in Baise People's Hospital for this retrospective cohort study. Baseline data and blood samples were collected, and patients were followed up for one year after inclusion. The AECOPD hospital readmission within one year was the outcome. Receiver operating characteristics (ROC) curves were conducted to determine the prognostic performance of DAR for predicting readmission within one year. The relationships between DAR, neutrophil-to-lymphocyte ratio (NLR), and AECOPD hospital readmission were conducted using univariate and multivariate logistic regression models, with odds ratios (ORs) and 95% confidence intervals (CIs). The relationship was further explored in different modified Medical Research Council (mMRC), COPD assessment test (CAT), COPD course, pneumonia, glucocorticoid, antibiotic subgroups.
Totally, 117 (22.99%) COPD patients were hospital readmission due to AECOPD. The area under the curve (AUC) for the DAR was 0.726. DAR ≥2.21 (OR=1.80, 95% CI: 1.05-3.17) was associated with elevated odds of AECOPD hospital readmission within one year. DAR ≥2.21 was related to increased odds of AECOPD hospital readmission in patients of those mMRC ≥2, CAT >20, COPD course <10 years, and pneumonia. NLR ≥3.69 was associated with higher odds of AECOPD hospital readmission in patients of those mMRC ≥2 and COPD course ≥10 years.
In patients with AECOPD, DAR showed a better predictive value in predicting the risk of hospital readmission in patients with AECOPD within one year. The findings of our study might help identify patients with a high risk of readmission within one year and provide timely treatment to prevent the reoccurrence of AECOPD.
探讨D - 二聚体与白蛋白比值（DAR）与慢性阻塞性肺疾病急性加重期（AECOPD）患者一年内再次入院的相关性。
2019年1月至2022年10月，509例慢性阻塞性肺疾病患者入选百色市人民医院进行这项回顾性队列研究。收集基线数据和血样，患者纳入后随访一年。观察指标为一年内因AECOPD再次入院情况。绘制受试者工作特征（ROC）曲线以确定DAR预测一年内再次入院的预后性能。采用单因素和多因素逻辑回归模型分析DAR、中性粒细胞与淋巴细胞比值（NLR）与AECOPD再次入院的关系，计算比值比（OR）和95%置信区间（CI）。并在不同的改良医学研究委员会（mMRC）、慢性阻塞性肺疾病评估测试（CAT）、慢性阻塞性肺疾病病程、肺炎、糖皮质激素、抗生素亚组中进一步探讨这种关系。
共有117例（22.99%）慢性阻塞性肺疾病患者因AECOPD再次入院。DAR的曲线下面积（AUC）为0.726。DAR≥2.21（OR = 1.80，95% CI：1.05 - 3.17）与一年内AECOPD再次入院几率升高相关。DAR≥2.21与mMRC≥2、CAT>20、慢性阻塞性肺疾病病程<10年及肺炎患者的AECOPD再次入院几率增加有关。NLR≥3.69与mMRC≥2且慢性阻塞性肺疾病病程≥10年患者的AECOPD再次入院几率较高有关。
在AECOPD患者中，DAR在预测AECOPD患者一年内再次入院风险方面显示出较好的预测价值。我们的研究结果可能有助于识别一年内再次入院风险较高的患者，并提供及时治疗以预防AECOPD复发。
