Objective: To explore the relevant factors associated with poor prognosis in patients suffering from chronic obstructive pulmonary disease (COPD) combined with pulmonary embolism (PE), and investigate the predictive value of the simplified pulmonary embolism severity index (sPESI) score on adverse outcomes in these patients. Methods: A total of 168 patients with COPD and PE who were treated at West China Hospital of Sichuan University from January 1, 2018, to December 30, 2020 were retrospectively included. Patients were divided into adverse outcome group and control group based on the occurrence of adverse outcomes [any of the following events: in-hospital death, intensive care unit (ICU) admission, and endotracheal intubation]. Correlation factors for poor prognosis were explored using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was employed to assess the predictive value of the sPESI score for adverse outcomes in COPD patients with PE. Results: A total of 168 patients were studied, with an age of (73.4±10.4) years and 119 male (70.8%). In the adverse outcome group, there were 18 cases (10.7%), including 12 in-hospital deaths, 6 ICU admission, and 1 endotracheal intubation. The control group comprised 150 cases (89.3%). Statistically significant differences were observed between two groups regarding the proportion of patients with diabetes, nephrotic syndrome, severe pneumonia, respiratory failure and lower extremity edema, and the pulse, diastolic blood pressure, pulse oxygen saturation, lactate dehydrogenase and cholesterol levels (all P<0.05). Multivariate logistic regression analysis revealed that severe pneumonia, respiratory failure, lower extremity edema, and diastolic blood pressure<60 mmHg (1 mmHg=0.133 kPa) are correlative factors of adverse outcomes in patients with COPD complicated by PE [OR (95%CI) were 7.363 (1.053-51.772), 4.077 (1.030-16.133), 4.490 (1.131-17.832), and 8.060 (1.209-53.918), respectively, all P<0.05]. The sPESI score in the adverse outcome group was higher than that in the control group [M (Q1, Q3), 2 (2, 2) vs 1 (1, 2) score, P=0.006]; the optimal cutoff value for sPESI score was 2 score, the sensitivity was 77.8%, the specificity was 54.0%, and the area under the curve (AUC) and 95%CI were 0.681 (0.554-0.809) based on the ROC curve analysis. Patients with sPESI≥2 score exhibited a 4.109-fold (95%CI: 1.292-13.063, P=0.017) increased risk of adverse prognosis compared to those with sPESI<2 score. Conclusions: Patients with COPD combined with PE have a higher incidence of adverse prognostic outcomes. Severe pneumonia, respiratory failure, lower limb edema, and diastolic pressure<60 mmHg are associated factors for poor prognosis. The sPESI score has some value in predicting adverse outcomes in COPD patients with PE.
目的： 探讨慢性阻塞性肺疾病（COPD）合并肺栓塞（PE）患者发生院内不良结局的相关因素及简化版肺栓塞严重指数（sPESI）评分对其预测价值。 方法： 回顾性纳入2018年1月1日至2020年12月30日于四川大学华西医院住院的168例COPD合并PE患者。按照是否发生院内不良结局［院内死亡、转入重症监护病房（ICU）及气管插管任一结局］分为不良结局组和对照组。通过多因素logistic回归模型分析探讨COPD合并PE患者院内不良结局的相关因素；采用受试者工作特征（ROC）曲线计算sPESI评分预测COPD合并PE患者发生院内不良结局的效能。 结果： 168例患者年龄（73.4±10.4）岁，男119例（70.8%），不良结局组18例（10.7%），其中院内死亡12例，转入ICU 6例，气管插管1例；对照组150例（89.3%）。两组糖尿病、肾病综合征、重症肺炎、呼吸衰竭、下肢水肿患者比例、脉搏、舒张压、脉搏血氧饱和度、乳酸脱氢酶和胆固醇差异均有统计学意义（均P<0.05）。多因素logistic回归模型显示，重症肺炎、呼吸衰竭、下肢水肿以及舒张压<60 mmHg（1 mmHg=0.133 kPa）是COPD合并PE患者发生院内不良结局的相关因素［OR值（95%CI）分别为7.363（1.053~51.772）、4.077（1.030~16.133）、4.490（1.131~17.832）、8.060（1.209~53.918），均P<0.05］。不良结局组的sPESI评分高于对照组［M（Q1，Q3），2（2，2）比1（1，2）分，P=0.006］。sPESI评分预测院内不良结局ROC曲线的最佳临界值为2分，灵敏度、特异度分别为77.8%和54.0%，曲线下面积（AUC）及95%CI为0.681（0.554~0.809）。sPESI≥2分者不良预后发生风险是sPESI<2分者的4.109倍（95%CI：1.292~13.063，P=0.017）。 结论： COPD合并PE患者不良预后发生率较高，重症肺炎、呼吸衰竭、下肢水肿以及舒张压<60 mmHg是不良预后发生的相关因素；sPESI在预测COPD合并PE患者不良预后中有一定价值。.