Objective To investigate the predictive value of the systemic coagulation-inflammation index (SCI) for in-hospital adverse outcomes in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This single-center retrospective study included 325 AECOPD patients hospitalized in the Department of Respiratory and Critical Care Medicine at the First Hospital of Lanzhou University from June 1, 2024, to June 1, 2025. Based on the occurrence of composite adverse outcomes during hospitalization, the patients were divided into an adverse outcome group (n=48) and a non-adverse outcome group (n=277). Baseline data and laboratory indicators within 48 hours of admission were collected, and SCI was calculated. Baseline characteristics were compared between the two groups. The diagnostic performance of SCI and commonly used hematological indicators for in-hospital adverse outcomes in the AECOPD patients was evaluated using receiver operating characteristic (ROC) curve analysis. Variables were screened by LASSO regression to develop a baseline predictive model (Model 1) incorporating age, history of acute exacerbation, C-reactive protein, partial pressure of carbon dioxide, and lymphocyte count. An enhanced model (Model 2) was constructed by adding SCI. Model performance was assessed using the area under the ROC curve (AUC), Bootstrap internal validation, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Results The median SCI in the adverse outcome group was 68.24, significantly lower than the 95.74 in the non-adverse outcome group (P<0.001), and low SCI was identified as an independent risk factor for in-hospital adverse outcomes in AECOPD patients. The AUC of Model 1 was 0.893 (95%CI 0.839-0.946). After adding SCI, Model 2 achieved an AUC of 0.909 (95%CI 0.859-0.960, P=0.044). Furthermore, after Bootstrap internal validation, the calibrated AUC of Model 2 was 0.899, confirming good model robustness.The IDI of Model 2 compared to Model 1 was 0.0426 (95%CI 0.0104-0.0790, P=0.012), indicating significant incremental predictive value. DCA demonstrated that using Model 2 for risk prediction provided greater net clinical benefit across a wide range of clinical decision thresholds. Conclusions Low SCI is an independent risk factor for in-hospital adverse outcomes in AECOPD patients. A new predictive model combining traditional clinical indicators with SCI shows favorable diagnostic performance, supporting early identification of high-risk patients in clinical practice.
Objective To explore the application effect of the clinical pathway for perianal day surgery based on enhanced recovery after surgery (ERAS) concept. Methods The case data of patients who underwent perianal surgery in the Department of Anorectal Surgery of Gansu Provincial Hospital between January and October 2023 and patients who underwent perianal day surgery based on the ERAS clinical pathway in the Ambulatory Surgery & Chemotherapy Centre of Gansu Provincial Hospital were retrospectively collected. The patients in the Department of Anorectal Surgery were defined as the control group, while the patients in the Ambulatory Surgery & Chemotherapy Centre were defined as the pathway group. The differences in indicators such as hospitalization cost, average hospitalization time, preoperative hospitalization time, surgical time, intraoperative bleeding, patient satisfaction, and postoperative follow-up between the two groups of patients were analyzed. Results A total of 400 patients were included, with 200 in each group. The differences between the two groups in gender and age were not statistically significant (P>0.05), the Visual Analogue Scale of the pathway group was lower than that of the control group (P<0.05), and the Kolcaba Comfort Scale score was higher than that of the control group (P<0.05). The hospitalization cost, average hospitalization time, preoperative hospitalization time, and surgical time of the pathway group were all lower than those of the control group (P<0.05), and there was no statistically significant difference in intraoperative bleeding between the two groups (P>0.05). The satisfaction rates of the pathway group and the control group were 90.5% and 86.0%, respectively, and there was no statistically significant difference between the two groups (P>0.05). The follow-up results showed that perianal day surgery did not increase the discomfort of patients after discharge. Conclusions The clinical pathway for day surgery based on ERAS concept is more conducive to the postoperative recovery of patients undergoing day surgery, reducing medical costs, improving medical quality, and increasing patient satisfaction. It is worthy of clinical promotion and application.