Aggarwal Ashutosh N, Agarwal Ritesh, Gupta Dheeraj, Jindal Surinder K
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012 India.
Chest. 2007 Sep;132(3):829-35. doi: 10.1378/chest.06-2783.
This study aimed to define the prevalence, severity, and progression of nonpulmonary organ dysfunction, and its impact on outcome in patients with acute respiratory failure (ARF) at a respiratory ICU of a tertiary referral hospital in northern India.
Daily patient data were collected on 711 adult patients with ARF to calculate component and total nonpulmonary sequential organ failure assessment (SOFA) scores. Hospital survival was the main outcome measure. Multiple logistic regression modeling was conducted to assess contribution of incremental dysfunction of various nonpulmonary organ systems to mortality. Kaplan-Meier curves were drawn to assess temporal trends in survival, and group comparisons were based on log-rank test. Cox proportional hazard modeling was performed to define hazards of earlier mortality. Discrimination was evaluated using receiver operating characteristic (ROC) curves.
Four hundred seventy-five patients (66.8%) had one or more nonpulmonary organ dysfunctions at hospital admission. The overall hospital mortality rate was 33.9%. Hospital survival rates and median survival declined steadily as the number of organs involved increased. Admission, maximum, and DeltaSOFA scores were significantly higher in nonsurvivors. Increasing baseline cardiovascular and neurologic SOFA scores, and corresponding DeltaSOFA scores, were associated with progressively higher odds of hospital mortality, as well as increasing hazard for earlier mortality after adjustment for etiology of respiratory failure. Maximum nonpulmonary SOFA score was the best discriminator in predicting mortality (area under ROC curve, 0.767).
Baseline and new-onset nonpulmonary organ dysfunction significantly influences hospital survival in patients with ARF.
本研究旨在确定印度北部一家三级转诊医院呼吸重症监护病房中急性呼吸衰竭（ARF）患者非肺部器官功能障碍的患病率、严重程度及进展情况，及其对预后的影响。
收集711例成年ARF患者的每日数据，以计算各组成部分及非肺部序贯器官衰竭评估（SOFA）总分。医院生存率是主要结局指标。进行多因素logistic回归建模，以评估各种非肺部器官系统功能障碍加重对死亡率的影响。绘制Kaplan-Meier曲线以评估生存时间趋势，并基于对数秩检验进行组间比较。进行Cox比例风险建模以确定早期死亡风险。使用受试者工作特征（ROC）曲线评估判别能力。
475例患者（66.8%）入院时存在一种或多种非肺部器官功能障碍。医院总体死亡率为33.9%。随着受累器官数量增加，医院生存率和中位生存时间稳步下降。非幸存者的入院、最高及DeltaSOFA评分显著更高。基线心血管和神经SOFA评分及相应的DeltaSOFA评分增加，与医院死亡率的逐渐升高以及在调整呼吸衰竭病因后早期死亡风险增加相关。最高非肺部SOFA评分是预测死亡率的最佳判别指标（ROC曲线下面积为0.767）。
基线及新发非肺部器官功能障碍显著影响ARF患者的医院生存率。
