The incidence rate of acute gastrointestinal injury and its prognostic value in patients with acute exacerbation of chronic obstructive pulmonary disease

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Objective To investigate the incidence rate of acute gastrointestinal injury (AGI) and its effect on prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The diagnosis, grades of AGI and other clinical data of 146 cases of AECOPD patients admitted from January 2009 to December 2015 in Maanshan Shiqiye Hospital were studied retrospectively. AECOPD patients with AGI were divided into the survival group (n = 72) and death group (n = 17) according to the survival condition within the 28-day period. The age, gender, complications and acute physiology and chronic health evaluation (APACHE) Ⅱscore, clinical pulmonary infection score (CPIS) and AGI grades were compared between the two groups. Based on APACHEⅡscores, AECOPD patients were divided into four groups: mild group (n = 39), severe group (n = 53), critically severe group (n = 35), and extremely severe group (n = 19). The incidence rate and 28-d mortality of AGI were evaluated among these four groups. According to CPIS, the patients were divided into three groups: mild group (n = 71), moderate group (n = 53), and severe group (n = 22); comparing the incidence rate and 28-d mortality of AGI in these three groups. Meanwhile, the 28-d mortality in different grades of AGI patients were analyzed. Results Among 146 AECOPD patients, 89 patients (60.96%) had AGI, and there were 53 (59.55%), 19 (21.35%), 11 (12.36%) and 6 (6.74%) cases in AGI grade Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively. There were statistically significant differences of prognosis among different AGI grades (P 0.05). However, the APACHEⅡscore [(20 ± 5) vs. (28 ± 5), t = 5.833, P< 0.001] and CPIS [(3.5 ± 1.5) vs. (5.4 ± 1.6), t = 4.568, P< 0.001] of the survival group were significantly lower than those of the death group. The incidence rate and 28-d mortality of AGI were significantly different in four APACHEⅡscore groups (χ2 = 27.369, 47.838; all P< 0.001), and also different in three CPIS groups (χ2 = 24.025, 47.453; all P< 0.001). In addition, the differences of 28-d mortality in four grades of AGI patients were statistically significant (1.89%, 15.79%, 63.64%, 100.00%; χ2 = 49.829, P < 0.05). Conclusions The incidence rate of AGI in AECOPD patients is quite high. The higher the AGI grade, the worse the prognosis. Thus, we should pay attention to the diagnosis and treatment of AGI in AECOPD patients. Key words: Chronic obstructive pulmonary disease; Acute gastrointestinal injury; Acute physiology and chronic health evaluation system Ⅱ; Clinical pulmonary infection score