Correlation analysis of quantitative CT parameters in chronic obstructive pulmonary disease and its mechanical ventila-tion outcome during acute exacerbation
Objective To analyze the correlation between CT quantitative parameters of chronic obstructive pulmonary disease(COPD)and the outcome of mechanical ventilation during acute exacerbation.Methods A retrospective analysis was performed on 252 patients with acute exacerbation of COPD(AECOPD)treated in our hospital from January 2021 to January 2023,the outcome of mechanical ventilation were obtained,and the patients were divided into a successful group and a failed group according to whether the machine was successfully withdrawn,with 187 cases and 65 cases,respectively.Logistic regres-sion was used to analyze the factors influencing the outcome of mechanical ventilation in AECOPD patients;risk column line dia-grams were used to construct a prediction model;ROC curves were used to analyze the predictive value of each CT quantitative parameter and prediction model;and decision curve analysis(DCA)was used to analyze the clinical applicability of the model.In addition,108 patients with mechanical ventilation of AECOPD admitted to our hospital from February 2023 to January 2024 were selected as the verification group to conduct external verification of the model.Results Percentage of low attenuation area(PLAA),square root of wall area with a theoretical airway circumference of 10 mm(RAA,10),whole lung airway wall area(AWA)wall thickness(TW),and percentage of wall area(PWA)of patients in the successful group of machine removal were lower than those in the failed group of machine removal,and the percentage of cross-sectional area of small pulmonary vessels＜5 mm2(PCSA＜5)of patients in the successful group of machine removal was higher in the successful group than in the failed group(all P＜0.05).Logistic regression analysis showed that PLAA,RAA,10,AWA,TW,PWA,and PCAS＜5 were all independent influences on the outcome of mechanical ventilation in patients with AECOPD(P＜0.05).The risk prediction model was tested by the Hos-mer-Lemeshow test,x2=10.985,P=0.203.The ROC analysis showed that the area under the curve(AUC)of PLAA,RAA,10 AWA,TW,PWA,PCAS＜5 alone and the risk prediction model were 0.767,0.714,0.729,0.764,0.637,0.651 and 0.946,and the AUC of the model was higher than the AUC of each individual test(P＜0.05).The AUC of ROC in the validation group was 0.914(P＜0.05).Conclusion PLAA,RAA,10,AWA,TW,PWA and PCAS＜5 in quantitative CT parameters are closely related to mechanical ventilation outcome in patients with AECOPD.The risk histogram model constructed based on quantitative CT param-eters is effective in predicting mechanical ventilation outcome in patients with AECOPD,and can be used to assist in clinical judgment of mechanical ventilation outcome.
维普
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