Ando Katsutoshi, Doi Tokuhide, Moody Sandra Y, Ohkuni Yoshihiro, Sato Sachiko, Kaneko Norihiro
Department of Pulmonology, Kameda Medical Center, Japan.
Intern Med. 2012;51(14):1835-40. doi: 10.2169/internalmedicine.51.6434. Epub 2012 Jul 15.
We conducted a retrospective study assessing the relationship between comorbidity, using the Charlson Comorbidity Index (CCI), and the prognoses of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) patients.
We analyzed the data of 47 patients with ALI and ARDS who were admitted to our center between April 2004 and July 2009. The patients were classified into 2 groups (survival and non-survival) 3 months after diagnosis, and demographic and clinical characteristics were analyzed. We also evaluated the ROC curve and Akaike's information criterion (AIC) to determine the most appropriate cut-off level for the CCI at 3 months survival. The survival rate was estimated based on the AIC results.
The mean age was 71.0 years; 25 (53%) of the patients died within 3 months of the diagnosis. Although age, etiology of ALI and ARDS, and APACHE II score did not differ between the two groups, smoking history, CCI, SOFA score, and steroid use were higher in the non-survival group than in the survival group. Age was not significantly correlated with CCI; however, CCI had weak, but statistically significant correlations with the APACHE II and SOFA scores (r=0.387, p<0.01 and r=0.288, p<0.05, respectively). AIC analysis revealed that a score of 4 on the CCI was the most appropriate cut off level for 3 months survival. The 3-month survival rate was lower in patients with a CCI≥4 than in those with a CCI<4 (9.5% vs. 55.5%, p<0.05).
This study showed that the prognosis of ALI and ARDS was affected more by comorbidity than by age, and that the CCI was useful for assessing patient comorbidities in ALI and ARDS. We have to consider that patients with a CCI score of 4 or more are at risk of developing multi-organ failure and have a poor prognosis.
我们进行了一项回顾性研究，使用查尔森合并症指数（CCI）评估合并症与急性肺损伤（ALI）及急性呼吸窘迫综合征（ARDS）患者预后之间的关系。
我们分析了2004年4月至2009年7月间入住我们中心的47例ALI和ARDS患者的数据。在诊断后3个月将患者分为两组（存活和非存活），并分析人口统计学和临床特征。我们还评估了ROC曲线和赤池信息准则（AIC），以确定3个月存活时CCI的最合适截断水平。根据AIC结果估计生存率。
平均年龄为71.0岁；25例（53%）患者在诊断后3个月内死亡。虽然两组之间的年龄、ALI和ARDS的病因以及急性生理与慢性健康状况评分系统II（APACHE II）评分无差异，但非存活组的吸烟史、CCI、序贯器官衰竭评估（SOFA）评分和类固醇使用情况高于存活组。年龄与CCI无显著相关性；然而，CCI与APACHE II和SOFA评分有弱但统计学上显著的相关性（分别为r = 0.387，p < 0.01和r = 0.288，p < 0.05）。AIC分析显示，CCI评分为4是3个月存活的最合适截断水平。CCI≥4的患者3个月生存率低于CCI<4的患者（9.5%对55.5%，p < 0.05）。
本研究表明，ALI和ARDS的预后受合并症的影响大于年龄，且CCI有助于评估ALI和ARDS患者的合并症情况。我们必须考虑到CCI评分4分及以上的患者有发生多器官功能衰竭的风险且预后较差。
