The relationship between alveolar NO and peripheral blood eosinophils and clinical characteristics of patients with acute exacerbation of COPD and their short-term prognostic value
Objective To investigate the relationship between alveolar nitric oxide(CaNO)and peripheral blood eosinophils(EOS)with the clinical characteristics and short-term prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods The clinical data of 1285 patients with acute exacerbation of COPD were retrospectively analyzed.Accord-ing to the level of peripheral blood EOS at admission,they were divided into group A(EOS%≥2%,n=528)and group B(EOS%<2%,n=757),and were divided into group C(CaNO>5ppb,n=562)and group D(CaNO≤5ppb,n=723)according to the level of CaNO at admission.The clinical characteristics,1-year acute exacerbation incidence and mortality rate between groups A and B,as well as between groups C and D were compared.The relationship between the levels of CaNO and peripheral blood EOS at admission with the clinical characteristics of the patients,the incidence of acute exacerbation within one year,and the mortality within one year were ana-lyzed.Receiver operating characteristic(ROC)curves were drawn to analyze the efficacy of CaNO and peripheral blood EOS levels alone and in combination to predict acute exacerbation and mortality within one year in patients with acute exacerbation of COPD.Results The volume of forceful expiration in the first second as a percentage of the predicted value(FEV1%pred)and the partial pressure of oxygen(PaO2)were higher and the length of hospital stay was shorter in group A than in group B.The partial pressure of carbon dioxide(PaCO2),the rate of mechanical ventilation,the rate of antibiotic coadministration,the rate of pulmonary and systemic hormone use,the total amount of hormone application,the incidence of acute exacerbations within one year,and the rate of death were all lower than in group B(P<0.05).The FEV1%pred and PaO2 of group C were lower than those of group D,the hospitalization time of group C was longer than that of group D,the PaCO2,rate of mechanical ventilation,rate of combined antibiotics,rate of pulmonary and systemic hor-mones,total amount of hormones used,the occurrence of acute exacerbation within 1 year and the rate and fatality rate within one year of group C were higher than those of group D(P<0.05).The levels of CaNO and peripheral blood EOS at admission in patients with acute exacerbation of COPD could affect their FEV1%pred,PaO2,PaO2,mechanical ventilation rate,combined antibiotic rate,hospital stay time,the incidence of acute exacerbation and fatality rate within one year(P<0.05).The results of ROC curve analysis showed that the combination of CaNO and peripheral blood EOS levels at admission had high sensitivity and accuracy in predicting acute exacerbation and death within 1 year in patients with acute exacerbation of COPD.Conclusion The illness severity and short-term prognosis of patients with EOS%≥2%and CaNO≤5ppb are better.The levels of CaNO and peripheral blood EOS are correlated with the clinical characteris-tics of patients with acute exacerbation of COPD and their short-term prognosis,which can be used as reference indicators for the evalu-ation of their illness severity and short-term prognosis.
AlveoliNitric oxideEosinophilsChronic obstructive pulmonary diseaseAcute exacerbationClinical features
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