Li Queque, Zhang Jiuzhi, Wan Xianyao
Department of Critical Care Medicine, Affiliated First Hospital, Institute of Critical Care Medicine, Dalian Medical University, Dalian 116011, Liaoning, China,Corresponding author: Wan Xianyao, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Nov;26(11):794-8. doi: 10.3760/cma.j.issn.2095-4352.2014.11.006.
To compare the characteristics and risk factors of prognosis between elder and young patients with acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).
The data of 150 patients meeting ARDS Berlin guideline who admitted to ICU of Affiliated First Hospital of Dalian Medical University from August 2011 to November 2013 were retrospectively analyzed. The patients over 65 years old were served as elderly group (n=78), and those younger than 65 years old were served as young group (n=72), and the patients were subdivided into survivors and non-survivors groups. The characteristics of patients at admission was recorded to investigate the characteristics of elder and young patients by univariate analysis. The univariate analysis was also conducted between different prognosis groups, and the risk factors of mortality were demonstrated by multivariate logistic analysis.
Compared with the young group, the hospital length of stays [days: 27.0 (16.0, 36.0) vs. 15.0 (8.0, 21.0), P=0.000], ICU length of days [days: 25.0 (15.0, 32.0) vs. 13.0 (7.0, 19.00), P = 0.000], mechanical ventilation days [days: 19.0 (11.0, 27.0) vs. 8.0 (5.0, 15.0), P = 0.000], the proportion of tracheotomy: [39.74% (31/78) vs. 18.06% (13/17), P = 0.003], the number of organ dysfunction (3.78 ± 0.49 vs. 1.97 ± 1.03,P=0.043) and creatinine (μmol/L:153.85 ± 16.89 vs. 108.26 ± 9.14, P = 0.017) of elderly group were significantly increased. The mortality [67.95% (53/78) vs. 59.72% (43/72), P = 0.190] and acute physiology and chronic health evaluation II (APACHEII) score (17.94 ± 6.04 vs. 15.99 ± 6.93, P = 0.068) in the elderly group were higher than those in the young group but without the significant differences. The causes of death in elderly patients were mainly with respiratory failure; the mainly causes in young and middle-aged patients were complex with multiple organ dysfunction syndrome, circulatory failure and other reasons. APACHEII score, the number of organ dysfunction, and maximum positive end-expiratory pressure (PEEP) in the non-survivors of the elderly group were significantly higher than those of the survivors [APACHEII score:19.45 ± 6.00 vs. 14.72 ± 4.83,the number of organ dysfunction:4.13 ± 0.88 vs. 2.16 ± 1.01,maximum PEEP(cmH₂O,1 cmH₂O = 0.098 kPa): 13.93 ± 4.16 vs. 9.72 ± 3.72, all P<0.01],and the proportion of tracheotomy and pH value were significantly lower than those of the survivors [the proportion of tracheotomy:32.08% (17/53) vs. 56.00% (14/25), pH value: 7.35 ± 0.14 vs. 7.42 ± 0.08, both P < 0.05]. Logistic analysis showed that APACHEII score [odds ratio (OR) = 7.068, 95% confidence interval (95% CI)= 1.358-3.273, P = 0.023],the number of organ dysfunction (OR = 2.328, 95% CI = 1.193-4.520, P = 0.029) were related with prognosis in elderly patients with ARDS. APACHEII score, the number of organ dysfunction, blood lactate, maximum PEEP in non-survivors of the young group were significantly higher than those of the survivors [APACHEII score: 18.12 ± 6.88 vs. 12.83 ± 5.80,the number of organ dysfunction:3.16 ± 1.23 vs. 2.55 ± 1.29, blood lactate(mmol/L): 4.84 ± 4.07 vs. 2.56 ± 1.86,maximum PEEP (cmH₂O): 13.93 ± 5.50 vs. 10.54 ± 4.05, P < 0.05 or P < 0.01], and the pH value, hospital length of stays, ICU length of days were significantly lower than those of the survivors [pH value: 7.30 ± 0.16 vs. 7.41 ± 0.10, hospital length of stays(days):11.09 ± 10.97 vs. 25.17 ± 19.05, ICU length of days (days): 8.0 (5.0, 13.0) vs. 20.0 (12.0, 31.0), all P < 0.01]. Multivariate logistic analysis showed that APACHEII score was related with the prognosis in young patients with ARDS (OR = 5.735, 95% C I= 1.921-3.310, P = 0.004).
Higher APACHEII score and the number of organ dysfunction were independent predictors of worse outcome in elder ARDS patients. Higher APACHEII score was the independent predictor of worse outcome in young ARDS patients.
比较重症监护病房（ICU）中老年与年轻急性呼吸窘迫综合征（ARDS）患者的临床特征及预后危险因素。
回顾性分析2011年8月至2013年11月大连医科大学附属第一医院ICU收治的150例符合ARDS柏林标准的患者资料。将年龄大于65岁的患者作为老年组（n = 78），年龄小于65岁的患者作为青年组（n = 72），再将两组患者分为存活组和非存活组。记录患者入院时的特征，采用单因素分析研究老年和年轻患者的特点。对不同预后组进行单因素分析，并通过多因素logistic分析确定死亡的危险因素。
与青年组比较，老年组患者的住院时间[天：27.0（16.0，36.0）比15.0（8.0，21.0），P = 0.000]、ICU住院天数[天：25.0（15.0，32.0）比13.0（7.0，19.00），P = 0.000]、机械通气天数[天：19.0（11.0，27.0）比8.0（5.0，15.0），P = 0.000]、气管切开比例[39.74%（31/78）比18.06%（13/72），P = 0.003]、器官功能障碍数量（3.78±0.49比1.97±1.03，P = 0.043）及肌酐水平（μmol/L：153.85±16.89比108.26±9.14，P = 0.017）均显著增加。老年组患者的死亡率[67.95%（53/78）比59.72%（43/72），P = 0.190]及急性生理与慢性健康状况评分II（APACHEII）（17.94±6.04比15.99±6.93，P = 0.068）高于青年组，但差异无统计学意义。老年患者的主要死亡原因是呼吸衰竭；中青年患者的主要死亡原因是复杂的多器官功能障碍综合征、循环衰竭等。老年组非存活患者的APACHEII评分、器官功能障碍数量及呼气末正压最大值（PEEP）显著高于存活患者[APACHEII评分：19.45±6.00比14.72±4.83，器官功能障碍数量：4.13±0.88比2.16±1.01，最大PEEP（cmH₂O，1 cmH₂O = 0.098 kPa）：13.93±4.16比9.72±3.72，P均<0.01]，气管切开比例及pH值显著低于存活患者[气管切开比例：32.08%（17/53）比56.00%（14/25），pH值：7.35±0.14比7.42±0.08，P均<0.05]。Logistic分析显示，APACHEII评分[比值比（OR）= 7.068，95%置信区间（95%CI）= 1.358 - 3.273，P = 0.023]、器官功能障碍数量（OR = 2.328，95%CI = 1.193 - 4.520，P = 0.029）与老年ARDS患者的预后相关。青年组非存活患者的APACHEII评分、器官功能障碍数量、血乳酸水平及PEEP最大值显著高于存活患者[APACHEII评分：18.12±6.88比12.83±5.80，器官功能障碍数量：3.16±1.23比2.55±1.29，血乳酸（mmol/L）：4.84±4.07比2.56±1.86，最大PEEP（cmH₂O）：13.93±5.50比10.54±4.05，P < 0.05或P < 0.01]，pH值、住院时间、ICU住院天数显著低于存活患者[pH值：7.30±0.16比7.41±0.10，住院时间（天）：11.09±10.97比25.17±19.05，ICU住院天数（天）：8.0（（5.0，13.0）比20.0（12.0，31.0），P均<0.01]。多因素logistic分析显示，APACHEII评分与青年ARDS患者的预后相关（OR = 5.735，95%CI = 1.921 - 3.310，P = 0.004）。
较高的APACHEII评分和器官功能障碍数量是老年ARDS患者预后不良的独立预测因素。较高的APACHEII评分是青年ARDS患者预后不良的独立预测因素。
