Department of Neurology, Division of Critical Care, Thomas Jefferson University, Jefferson College of Medicine, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2012 Oct;71(4):795-803. doi: 10.1227/NEU.0b013e3182672ae5.
Traumatic brain injury (TBI) is a major cause of disability, morbidity, and mortality. The effect of the acute respiratory distress syndrome and acute lung injury (ARDS/ALI) on in-hospital mortality after TBI remains controversial.
To determine the epidemiology of ARDS/ALI, the prevalence of risk factors, and impact on in-hospital mortality after TBI in the United States.
Retrospective cohort study of admissions of adult patients>18 years with a diagnosis of TBI and ARDS/ALI from 1988 to 2008 identified through the Nationwide Inpatient Sample.
During the 20-year study period, the prevalence of ARDS/ALI increased from 2% (95% confidence interval [CI], 2.1%-2.4%) in 1988 to 22% (95% CI, 21%-22%) in 2008 (P<.001). ARDS/ALI was more common in younger age; males; white race; later year of admission; in conjunction with comorbidities such as congestive heart failure, hypertension, chronic obstructive pulmonary disease, chronic renal and liver failure, sepsis, multiorgan dysfunction; and nonrural, medium/large hospitals, located in the Midwest, South, and West continental US location. Mortality after TBI decreased from 13% (95% CI, 12%-14%) in 1988 to 9% (95% CI, 9%-10%) in 2008 (P<.001). ARDS/ALI-related mortality after TBI decreased from 33% (95% CI, 33%-34%) in 1988 to 28% (95% CI, 28%-29%) in 2008 (P<.001). Predictors of in-hospital mortality after TBI were older age, male sex, white race, cancer, chronic kidney disease, hypertension, chronic liver disease, congestive heart failure, ARDS/ALI, and organ dysfunctions.
Our analysis demonstrates that ARDS/ALI is common after TBI. Despite an overall reduction of in-hospital mortality, ARDS/ALI carries a higher risk of in-hospital death after TBI.
创伤性脑损伤（TBI）是导致残疾、发病率和死亡率的主要原因。急性呼吸窘迫综合征和急性肺损伤（ARDS/ALI）对 TBI 后院内死亡率的影响仍存在争议。
确定美国 TBI 后 ARDS/ALI 的流行病学、危险因素的流行情况以及对院内死亡率的影响。
通过全国住院患者样本，对 1988 年至 2008 年间成年患者 TBI 和 ARDS/ALI 诊断的住院患者进行回顾性队列研究。
在 20 年的研究期间，ARDS/ALI 的患病率从 1988 年的 2%（95%置信区间[CI]，2.1%-2.4%）增加到 2008 年的 22%（95%CI，21%-22%）（P<.001）。ARDS/ALI 在较年轻的年龄；男性；白种人；较晚的入院年份；并发充血性心力衰竭、高血压、慢性阻塞性肺疾病、慢性肾功能和肝功能衰竭、败血症、多器官功能障碍等合并症；以及非农村、中型/大型医院，位于中西部、南部和西部美国大陆。TBI 后的死亡率从 1988 年的 13%（95%CI，12%-14%）下降到 2008 年的 9%（95%CI，9%-10%）（P<.001）。TBI 后与 ARDS/ALI 相关的死亡率从 1988 年的 33%（95%CI，33%-34%）下降到 2008 年的 28%（95%CI，28%-29%）（P<.001）。TBI 后院内死亡的预测因素为年龄较大、男性、白种人、癌症、慢性肾脏病、高血压、慢性肝病、充血性心力衰竭、ARDS/ALI 和器官功能障碍。
我们的分析表明，ARDS/ALI 在 TBI 后很常见。尽管院内死亡率总体下降，但 ARDS/ALI 后 TBI 后院内死亡的风险更高。
