关键词: 乳酸/白蛋白比值, 慢性阻塞性肺疾病, 急性加重, 通气治疗, 预后评估

Abstract:

Objective To investigate the role of blood lactic acid （Lac）/albumin （Alb） ratio in the prognostic evaluation of ventilation therapy in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods A total of 235 patients with AECOPD were enrolled from Deqing County People's Hospital from March 2021 to March 2023. Baseline data were collected at admission，and Lac and Alb levels were determined to calculate Lac/Alb ratio. Based on the prognosis during ventilation therapy and a one-year follow-up，the patients were classified into short-term good prognosis group，short-term poor prognosis group，long-term good prognosis group and long-term poor prognosis group. Multivariate Logistic regression was used to analyze the factors affecting the short-term and long-term prognosis. The efficacy of ventilation therapy in AECOPD patients with poor short-term and long-term prognosis was evaluated by various indicators. Results During ventilation therapy，60 out of 235 AECOPD patients （25.53%） had poor prognosis. After a one-year follow-up，68 out of 235 AECOPD patients （28.94%） had poor prognosis. The proportion of patients aged≥60 years，mechanical ventilation，acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score，Lac levels and Lac/Alb ratio in short-term poor prognosis group were all higher than those in short-term good prognosis group （P<0.05），while Alb was lower（P<0.05）. There was no statistical significance in the other data between the 2 groups （P>0.05）. The areas under curves （AUC） of APACHE Ⅱ score，Lac，Alb，Lac/Alb ratio and APACHE Ⅱ score combined with Lac/Alb ratio for predicting short-term poor prognosis in AECOPD patients were 0.824，0.732，0.742，0.827 and 0.910，respectively. Age，APACHE Ⅱ score，Lac，Alb and Lac/Alb ratio were the influencing factors for the short-term prognosis of AECOPD patients （P<0.05）. The proportion of patients aged≥60 years，the proportion of patients with concomitant coronary heart disease，APACHE Ⅱ score，Lac and Lac/Alb ratio in long-term poor prognosis group were all higher than those in long-term good prognosis group （P<0.05），while Alb was lower（P<0.001）. There was no statistical significance in the other parameters between the 2 groups （P>0.05）. The AUC of APACHE Ⅱ score，Lac，Alb，Lac/Alb ratio and APACHE Ⅱ score combined with Lac/Alb ratio for predicting long-term poor prognosis were 0.835，0.745，0.776，0.844 and 0.926，respectively. APACHE Ⅱ score，coronary heart disease，Alb and Lac/Alb ratio were the influencing factors for the long-term prognosis of AECOPD patients （P<0.05）. Conclusions The Lac/Alb ratio is associated with both short-term and long-term prognosis of ventilation therapy in AECOPD patients. The Lac/Alb ratio combined with APACHE Ⅱ score，Lac and Alb have high predictive value for both short-term and long-term prognosis of ventilation therapy in AECOPD patients.

Key words: Lactic acid/albumin ratio, Chronic obstructive pulmonary disease, Acute exacerbation, Ventilation therapy, Prognostic assessment