Predictive Value of Keap1-Nrf2-ARE Pathway for the Risk of Death of Elderly Patients with COPD Complicated with Severe Respiratory Failure
Objective To investigate the predictive value of Keap1-Nrf2-ARE pathway for the risk of death in elderly patients with chronic obstructive pulmonary disease(COPD)combined with severe respiratory failure.Methods A total of 124 elderly patients with COPD combined with severe respiratory failure admitted to Xuchang Central Hospital Affiliated to Henan University of Science and Technology from January 2020 to June 2022 were selected as the study group,and 124 elderly patients with COPD without severe respiratory failure during the same period were selected as the control group.According to the prognosis after 28 days of treatment,the study group were divided into two subgroups,death(42 cases)and survival(82 cases).The expression levels of Kelch-like epichlorohydrin-associated protein-1(Keap1),nuclear factor E2(Nrf2)and antioxidant response element(ARE)in peripheral blood and acute physiology and chronic health status Ⅱ(APACHE Ⅱ)scores were compared between the two groups on admission and patients with different prognosis,7 and 14 days after treatment were comoard.The correlation between the expression levels of Keap1,Nrf2 and ARE in peripheral blood on admission and APACHE Ⅱ score and severe respiratory failure were analyzed,and partial regression was used to analyze the influencing factors of death in elderly patients with COPD combined with severe respiratory failure.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of peripheral blood Keap1,Nrf2,ARE expression levels for mortality in elderly COPD patients with severe respiratory failure.Results The expression levels of Keap1,Nrf2 and ARE in the peripheral blood of the study group were lower than those of the control group,and the APACHE Ⅱ score was higher than that of the control group(P＜0.05).The expression levels of Keap1,Nrf2 and ARE in peripheral blood were negatively correlated with APACHE Ⅱ score and severe respiratory failure(P＜0.05).The expression levels of Keap1,Nrf2 and ARE in peripheral blood of patients who died after 7 and 14 days of treatment were lower than those of patients who survived(P＜0.05).Logistic regression analysis showed that Keap1,Nrf2,ARE levels after 7 and 14 days of treatment were protective factors for death in elderly patients with COPD combined with severe respiratory failure(P＜0.05).After 7 and 14 days of treatment,the combined prediction of Keap1,Nrf2,and ARE expression levels in peripheral blood for mortality in elderly COPD patients with severe respiratory failure had area under the curve(AUC)values of 0.740 and 0.818,respectively,which were higher than those predicted by a single indicator(P＜0.05).Conclusion Keap1,Nrf2 and ARE are involved in the occurrence and development of COPD complicated with severe respiratory failure in the elderly,and have high efficacy in assisting clinical prediction of the risk of death.
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