年龄、动脉血氧分压/吸入氧分数值及平台压评分：急性呼吸窘迫综合征患者简单预后评分方案

Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.

作者信息

Villar Jesús, Ambrós Alfonso, Soler Juan Alfonso, Martínez Domingo, Ferrando Carlos, Solano Rosario, Mosteiro Fernando, Blanco Jesús, Martín-Rodríguez Carmen, Fernández María Del Mar, López Julia, Díaz-Domínguez Francisco J, Andaluz-Ojeda David, Merayo Eleuterio, Pérez-Méndez Lina, Fernández Rosa Lidia, Kacmarek Robert M

机构信息

1CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 2Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain. 3Intensive Care Unit, Hospital General de Ciudad Real, Ciudad Real, Spain. 4Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain. 5Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 6Post-Surgical Unit, Department of Anesthesia, Hospital Clínico de Valencia, Valencia, Spain. 7Intensive Care Unit, Hospital Virgen de la Luz, Cuenca, Spain. 8Intensive Care Unit, Hospital Universitario A Coruña, Coruña, Spain. 9Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. 10Intensive Care Unit, Hospital Universitario Mutua de Terrassa, Barcelona, Spain. 11Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 12Intensive Care Unit, Hospital General de León, León, Spain. 13Intensive Care Unit, Hospital Clínico de Valladolid, Valladolid, Spain. 14Intensive Care Unit, Hospital del Bierzo, Ponferrada, León, Spain. 15Research Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard University, Boston, MA.

出版信息

Crit Care Med. 2016 Jul;44(7):1361-9. doi: 10.1097/CCM.0000000000001653.

DOI:10.1097/CCM.0000000000001653

PMID:27035239

Abstract

OBJECTIVES

Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis.

DESIGN

A prospective, multicenter, observational, descriptive, and validation study.

SETTING

A network of multidisciplinary ICUs.

PATIENTS

Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort.

CONCLUSIONS

A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.

摘要

目的

尽管对于急性呼吸窘迫综合征的特征已基本达成共识，但我们仍缺乏一个能高概率预测急性呼吸窘迫综合征预后的评分系统。我们的目标是开发一种结局评分，临床医生可在床边轻松计算，以预测急性呼吸窘迫综合征患者诊断后24小时的死亡风险。

设计

一项前瞻性、多中心、观察性、描述性和验证性研究。

地点

多学科重症监护病房网络。

患者

600名符合中度和重度急性呼吸窘迫综合征柏林标准的患者，纳入两个接受肺保护性通气治疗的独立队列。

干预措施

无。

测量指标及主要结果

利用急性呼吸窘迫综合征诊断后24小时的个体人口统计学、肺部和全身数据，我们在300例急性呼吸窘迫综合征患者中根据变量值分层为三分位数得出预测评分，并在300例急性呼吸窘迫综合征患者的独立队列中进行验证。主要结局是住院死亡率。我们发现，基于急性呼吸窘迫综合征诊断后24小时患者年龄、PaO2/FIO2比值和平台压的9分评分与死亡相关。评分大于7分的患者死亡率为83.3%（相对风险，5.7；95%CI，3.0 - 11.0），而评分小于5分的患者死亡率为14.5%（p < 0.0000001）。我们在验证队列中证实了该评分的预测有效性。