Establishment of prediction model for mechanical ventilation weaning failure of AECOPD patients based on iNOS and eNOS levels in serum

Guo Zhiqian; Liu Yunfeng; Gao Xiaoling; Li Runjie; Zhao Lichun

doi:10.3969/j.issn.1002-1949.2024.07.008

Abstract：Objective To establish the prediction model for mechanical ventilation weaning failure of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients based on inducible nitric oxide synthase(iNOS)and endothelial nitric oxide synthase(eNOS)levels in serum.Methods A total of 166 AECOPD patients who underwent mechanical ventilation treatment in the First Affiliated Hospital of Hebei North University from January 2020 to June 2023 were selected and divided into successful group(n=112)and failed group(n=54)based on the weaning outcome.The clinical data and serum iNOS and eNOS levels at admission and before spontaneous breathing test(SBT)between two groups of patients were compared.Logistic regression analysis was used to analyze the influencing factors of weaning failure,and receiver operating characteristic(ROC)curve analysis was used to analyze the value of iNOS and eNOS in predicting weaning failure.Results Compared with the successful group,the failed group had higher levels of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ),creatinine(Cr),iNOS,eNOS,and lower level of albumin(Alb)within 24 hours before SBT(P＜0.05).Multivariate Logistic regression analysis showed that APACHE Ⅱ,Alb,iNOS and eNOS were the influencing factors for weaning failure(P＜0.05).The ROC curve analysis showed that the area under the ROC curve for iNOS and eNOS predicting weaning failure was 0.648(95％CI 0.563-0.733,P=0.002),0.755(95％CI 0.683-0.827,P＜0.001)with the optimal cutoff values of 4.418 ng/mL and 3.821 ng/mL,the predicted sensitivity was 68.52％and 83.33％,the specificity was 51.82％and 66.36％,respectively.The area under the ROC curve of iNOS,eNOS,APACHE Ⅱand Alb combined prediction of weaning failure was 0.961(95％CI 0.928-0.993),which was superior to a single indicator(Z=7.412,6.682,4.323,4.951,P＜0.05)with the sensitivity of 94.44％and the specificity of 90.91％.Conclusions The increased iNOS and eNOS levels in serum before SBT in AECOPD patients is associated with weaning failure.Combined detection of Alb,iNOS,eNOS and APACHE Ⅱ before SBT have good predictive value for weaning outcomes.