Prognostic value of serum DcR3 combined with urinary L-FABP in noninvasive ventilation therapy for AECO-PD patients with respiratory failure

XIE Qian-nan; ZHAI Shi-na; YE Jing; CHENG Xiao-xian; LI Jin-jun

doi:10.13820/j.cnki.gdyx.20251378

Abstract：Objective To investigate the early warning value of serum decoy receptor 3(DcR3)combined with urinary liver-type fatty acid-binding protein(L-FABP)for patients with acute exacerbation of chronic obstructive pul-monary disease(AECOPD)complicated by respiratory failure undergoing noninvasive ventilation(NIV).Methods A total of 125 AECOPD patients with respiratory failure receiving NIV treatment from April 2023 to January 2025 were en-rolled.Demographic characteristics and clinical assessment indicators were collected.Serum DcR3 and urinary L-FABP levels were measured before NIV treatment,and at 24 h and 72 h after treatment.Patients were followed up dynamically for 30 days after discharge and divided into a favorable prognosis group and an unfavorable prognosis group.Multivariate logistic regression models were established:Model 1 including demographic and clinical indicators,Model 2 including post-treatment DcR3 and urinary L-FABP levels,and a combined model.Receiver operating characteristic(ROC)curves were used to evaluate predictive performance.Results Among the 125 patients,97(77.6％)had favorable prog-nosis,and 28(22.4％)had unfavorable prognosis.The unfavorable prognosis group had longer COPD duration,longer treatment duration,lower FEV1％and PaO2,and higher mMRC,APACHE Ⅱ,PaCO2,serum creatinine,and IPAP compared with the favorable prognosis group(all P＜0.05).DcR3 and urinary L-FABP levels decreased over time in both groups(P＜0.05),but levels at 24 h and 72 h post-treatment were significantly higher in the unfavorable prognosis group(P＜0.001).The AUC(95％CI),sensitivity,and specificity of the combined model were 0.904(0.857-0.942),98.4％,and 88.6％,respectively,outperforming Model 1(AUC 0.744)and Model 2(AUC 0.801).The AUC,sensitivity and specificity of Model 2 were significantly higher than those of Model 1(0.801 vs.0.744,85.0％vs.73.5％,78.2％vs.59.0％,P＜0.05).Conclusion Serum DcR3 combined with urinary L-FABP has significant early warning value for prognosis in AECOPD patients with respiratory failure receiving NIV.The combined model provides better predictive accuracy than single models.Dynamic monitoring of these biomarkers may help identify high-risk pa-tients and guide early therapeutic interventions.