Kao Kuo-Chin, Chang Chih-Hao, Hung Chen-Yiu, Chiu Li-Chung, Huang Chung-Chi, Hu Han-Chung
Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Respiratory Therapy, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
PLoS One. 2017 Jul 5;12(7):e0180018. doi: 10.1371/journal.pone.0180018. eCollection 2017.
Diffuse alveolar damage (DAD) is a typical pathological finding of open lung biopsies in patients with acute respiratory distress syndrome (ARDS). Patients with ARDS and DAD have been reported to have a poorer prognosis than those without DAD. The aim of this study was to investigate the survival predictors in patients with ARDS and DAD.
We retrospectively reviewed all ARDS patients who underwent an open lung biopsy which showed evidence of DAD from January 2006 to June 2015 at Chang Gung Memorial Hospital. Clinical data including baseline characteristics, medication, and survival outcomes were analyzed.
A total of 64 ARDS patients with DAD were eligible for analysis and divided into known etiology (n = 17, 26.6%) and unknown etiology groups (n = 47, 73.4%). There was no significant difference in hospital mortality rate between the two groups (71.9% vs. 70.6%, p = 0.890). Univariate logistic regression analysis revealed that sequential organ failure assessment (SOFA) score at the time of a diagnosis of ARDS, and SOFA score, PaO2/FiO2 ratio, and positive end expiratory pressure level when the biopsy was performed were associated with hospital mortality. Multivariate analysis showed that the SOFA score on the day of the biopsy was an independent predictor of hospital mortality (odds ratio 1.413, 95% confidence interval 1.127-1.772; p = 0.03). There were no significant differences in the use, dose, duration and timing from ARDS to glucocorticoid therapy between the survivors and nonsurvivors.
For selected ARDS patients who underwent an open lung biopsy with pathological DAD, SOFA score was an independent predictor of hospital mortality.
弥漫性肺泡损伤（DAD）是急性呼吸窘迫综合征（ARDS）患者开放性肺活检的典型病理表现。据报道，患有ARDS和DAD的患者预后比没有DAD的患者更差。本研究的目的是调查ARDS和DAD患者的生存预测因素。
我们回顾性分析了2006年1月至2015年6月在长庚纪念医院接受开放性肺活检且显示有DAD证据的所有ARDS患者。分析了包括基线特征、用药情况和生存结局在内的临床数据。
共有64例患有DAD的ARDS患者符合分析条件，分为已知病因组（n = 17，26.6%）和未知病因组（n = 47，73.4%）。两组的医院死亡率无显著差异（71.9%对70.6%，p = 0.890）。单因素逻辑回归分析显示，ARDS诊断时的序贯器官衰竭评估（SOFA）评分，以及活检时的SOFA评分、PaO2/FiO2比值和呼气末正压水平与医院死亡率相关。多因素分析表明，活检当天的SOFA评分是医院死亡率的独立预测因素（比值比1.413，95%置信区间1.127 - 1.772；p = 0.03）。幸存者和非幸存者在ARDS至糖皮质激素治疗的使用、剂量、持续时间和时间上无显著差异。
对于接受开放性肺活检且病理显示为DAD的特定ARDS患者，SOFA评分是医院死亡率的独立预测因素。
