Objective: To investigate the risk factors associated with in-hospital mortality in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: A total of 6 668 patients hospitalized for AECOPD in seven tertiary hospitals from September 2017 to January 2021 were consecutively included, and clinical data related to medical history, laboratory tests, treatment and prognosis were collected, and patients were divided into death group and survival group according to whether they died during hospitalization. After univariate analysis, multivariate logistic regression analysis was then performed to explore the independent risk factors related to in-hospital mortality. Results: Among 6 668 patients hospitalized for AECOPD, 128 patients experienced in-hospital death, with a mortality rate of 1.9%. The mean age of the death group was (81±9) years, which was significantly older than that of the survival group ((72±11) years P<0.001). The proportion of patients in the AECOPD in-hospital death group with a combination of prolonged bed rest, hypertension, myocardial infarction within 3 months, cardiac insufficiency, chronic pulmonary heart disease, pneumonia, type 2 diabetes, venous thromboembolism (VTE), and chronic renal insufficiency was also significantly higher than in the survival group (all P<0.05) The median length of stay in the in-hospital death group was 18 d, which was significantly longer than that in the survival group (9 d, P<0.001), and the proportion of patients admitted to the ICU, receiving invasive mechanical ventilation and non-invasive mechanical ventilation was also significantly higher than that in the survival group (all P<0.05). The white blood cell count, glutamic transaminase, blood creatinine, calcitoninogen, C-reactive protein, D-dimer, N-terminal B-type natriuretic and Pseudomonas aeruginosa infection rates were significantly higher than those in the survival group (all P<0.05). Multifactorial analysis showed that age>80 years (OR=3.82, 95%CI 2.36 to 6.18, P<0.001), prolonged bed rest (OR=2.95, 95%CI: 1.79 to 4.86, P<0.001), chronic pulmonary heart disease (OR=1.85, 95%CI: 1.14 to 3.00, P=0.012), and pneumonia (OR=2.75, 95%CI: 1.65 to 4.60, P<0.001), invasive mechanical ventilation (OR=7.33, 95%CI: 4.40 to 12.21, P<0.001), noninvasive mechanical ventilation (OR=3.73, 95%CI: 2.30 to 6.04, P<0.001), anemia (OR=2.03. 95%CI: 1.21 to 3.42, P=0.008), and calcitoninogen>0.5 ng/ml (OR=2.38, 95%CI: 1.41 to 4.02, P=0.001) were independent risk factors for in-hospital mortality in patients with AECOPD. Conclusion: Advanced age (>80 years), prolonged bed rest, chronic pulmonary heart disease, pneumonia, invasive mechanical ventilation, noninvasive mechanical ventilation, anemia, and calcitoninogen>0.5 ng/ml were independent risk factors for in-hospital mortality in patients hospitalized with AECOPD.
目的： 探讨慢性阻塞性肺疾病急性加重（AECOPD）住院患者院内死亡的相关因素。 方法： 纳入2017年9月至2021年1月国内7家三甲医院因AECOPD住院的6 668例患者，收集病史、实验室检查、治疗、预后等相关临床资料，根据患者住院期间是否死亡分为死亡组和生存组，经单因素分析后，对可能有意义的因素再进行多因素logistic回归分析，探讨患者院内死亡的危险因素。 结果： 6 668例患者中，128例患者发生院内死亡，死亡率为1.9%。AECOPD院内死亡组患者的年龄为（81±9）岁，明显高于生存组［（72±11）岁，P<0.001］。AECOPD院内死亡组患者合并长时间卧床、高血压、3个月内心肌梗死、心功能不全、慢性肺源性心脏病、肺炎、2型糖尿病、静脉血栓栓塞症（VTE）、慢性肾功能不全的比例也明显高于生存组（均P<0.05）。AECOPD院内死亡组患者的中位住院时间为18 d，明显长于生存组（9 d，P<0.001），入住重症监护病房（ICU）、接受有创机械通气和无创机械通气的患者比例也均明显高于生存组（均P<0.05）。AECOPD院内死亡组患者的血细胞比容、血红蛋白、嗜酸性粒细胞比例和白蛋白水平明显低于生存组，而白细胞计数、天冬氨酸转氨酶、血肌酐、降钙素原、C反应蛋白、D-二聚体、尿钠肽和铜绿假单胞菌感染率明显高于生存组（均P<0.05）。多因素分析显示，年龄>80岁（OR=3.82，95%CI：2.36~6.18，P<0.001）、长时间卧床（OR=2.95，95%CI：1.79~4.86，P<0.001）、慢性肺源性心脏病（OR=1.85，95%CI：1.14~3.00，P=0.012）、肺炎（OR=2.75，95%CI：1.65~4.60，P<0.001）、有创机械通气（OR=7.33，95%CI：4.40~12.21，P<0.001）、无创机械通气（OR=3.73，95%CI：2.30~6.04，P<0.001）、贫血（OR=2.03，95%CI：1.21~3.42，P=0.008）、降钙素原>0.5 ng/ml（OR=2.38，95%CI：1.41~4.02，P=0.001）是AECOPD患者院内死亡的危险因素。 结论： 高龄（>80岁）、长时间卧床、慢性肺源性心脏病、肺炎、有创机械通气、无创机械通气、贫血、降钙素原>0.5 ng/ml是AECOPD住院患者院内死亡的危险因素。.