Prognostic Value of Blood Lactic Acid and Lactic Clearance Rate Com-bined with Non-invasive Hemodynamic Monitoring in Patients with Acute Exacerbation of COPD Complicated with Respiratory Failure

QIAN Jing; JIN Xiaole

doi:10.3969/j.issn.2095-3097.2023.05.005

Abstract：Objective To investigate the clinical value of blood lactic acid and blood lactic acid clearance(LCR)combined with non-invasive hemodynamic monitoring in predicting prognosis of patients with acute exacerbation of chronic ob-structive pulmonary disease(AECOPD)complicated with respiratory failure(RF).Methods A total of 100 patients with AECOPD complicated with RF admitted from January to December 2022 were selected for conventional treatment after admis-sion.The 28-day prognosis was recorded and they were divided into poor prognosis(death)group and good prognosis(surviv-al)group.Clinical data,hemodynamic indexes[cardiac index(CI),cardiac output(CO),systemic vascular resistance in-dex(SVRI),stroke volume(SV)],blood lactic acid and blood LCR of the two groups were compared,and adverse prognos-tic factors were analyzed.The prognostic value of hemodynamic indexes,blood lactic acid,and LCR in patients with AECOPD and RF was analyzed.The predictive effect of the prediction schemes with and without hemodynamic indexes,blood lactic acid,and LCR was further evaluated by area under the receiver operating characteristic(AUC)curve,net reclassification in-dex(NRI),and integrated discriminant improvement index(IDI).Results The 28-day fatality rate of 100 patients with AECOPD combined with RF was29.00％(29/100).The proportion of age,acute exacerbations≥2 times/year,the propor-tion of SVRI,blood lactic acid and LCR＜10％at 24 h after treatment in the poor prognosis group were higher than those in the good prognosis group,the duration of mechanical ventilation and length of hospital stay were longer than those in the good prognosis group,and the CI,CO and SV at 24 h after treatment were lower than those in the good prognosis group(P＜0.01).Age,number of acute exacerbations,duration of mechanical ventilation,as well as SVRI and blood lactic acid at 24 h after treatment were influencing factors of poor prognosis in AECOPD patients with RF,while CI,CO,SV and LCR at 24 h after treatment were protective factors(P＜0.01).At 24 h after treatment,the AUC of CI,CO,SVRI,SV,blood lactic acid and LCR for predicting poor prognosis was 0.778,0.767,0.779,0.814,0.804 and 0.909,respectively.The AUC of the prediction scheme with hemodynamic index,blood lactic acid and LCR was greater than that of the conventional prediction scheme(P＜0.05).Further NRI and IDI analysis showed that compared with the conventional prediction scheme,the predic-tion effect of the prediction scheme with hemodynamic index,blood lactic acid and LCR was significantly improved(P＜0.05).Conclusion Blood lactic acid and LCR combined with non-invasive hemodynamic monitoring in patients with AECOPD and RF have good efficacy in predicting prognosis.