Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
Department of Radiology, Kiniki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan.
BMJ Open. 2017 Nov 8;7(11):e015330. doi: 10.1136/bmjopen-2016-015330.
To report the clinical features and prognosis of drug-associatedacute respiratory distress syndrome (ARDS).
A retrospective analysis of data collected during a prospective cohort study.
Intensive care unit in a teaching hospital.
A total of 197 Japanese patients with ARDS diagnosed by the Berlin definition who were admitted to the Division of Respiratory Medicine from October 2004 to December 2015 were enrolled in the study and were classified as two groups according to their causes: a drug-associated ARDS group (n=27) and a non-drug-associated ARDS group (n=170). Primary outcome measure is 28-day mortality, and the secondaryoutcome measure is ventilator-free days.
The Acute Physiology and Chronic Health Evaluation II scores were significantly lower in the drug-associated ARDS group than in the non-drug-associated ARDS group (median (IQR): 18.0 (16.5-21.0) vs 23.0 (18.0-26.0), p<0.001), and the arterial oxygen tension/fractional inspired oxygen ratio was higher (148.0 (114.1-177.5) vs 101.0 (71.5-134.0), p=0.003). In the drug-associated ARDS group, although high-resolution CT scores indicative of the extent of fibroproliferation (301.6 (244.1-339.8) vs 208.3 (183.4-271.6), p<0.001), serum lactate dehydrogenase levels (477 (365-585) vs 322 (246-434), p=0.003) and the McCabe scores (score 1/2/3, n (%): 20 (74)/4 (15)/3 (11)vs154 (91)/7 (4)/9 (5), p=0.04) were significantly higher, ventilator weaning was earlier (p<0.001) and 28-day mortality was better (p=0.043). After adjusting for potentially confounding covariates, drug-associated ARDS group was associated with lower 28-day mortality (adjusted HR (HR) 0.275; 95% CI 0.106 to 0.711; p=0.008).
Although more severe lung damage with fibroproliferation was observed in patients with drug-associated ARDS, ventilator weaning was earlier, and their prognosis was better than the others. Further well-designed prospective studies are needed.
报告药物相关性急性呼吸窘迫综合征（ARDS）的临床特征和预后。
前瞻性队列研究中数据的回顾性分析。
教学医院的重症监护病房。
2004 年 10 月至 2015 年 12 月期间，根据柏林定义诊断为 ARDS 的 197 例日本 ARDS 患者被纳入研究，并根据病因分为两组：药物相关性 ARDS 组（n=27）和非药物相关性 ARDS 组（n=170）。主要结局指标为 28 天死亡率，次要结局指标为无呼吸机天数。
药物相关性 ARDS 组的急性生理学和慢性健康评估 II 评分明显低于非药物相关性 ARDS 组（中位数（IQR）：18.0（16.5-21.0）比 23.0（18.0-26.0），p<0.001），动脉血氧分压/吸入氧分数比更高（148.0（114.1-177.5）比 101.0（71.5-134.0），p=0.003）。在药物相关性 ARDS 组中，尽管提示纤维增生程度的高分辨率 CT 评分较高（301.6（244.1-339.8）比 208.3（183.4-271.6），p<0.001）、血清乳酸脱氢酶水平（477（365-585）比 322（246-434），p=0.003）和 McCabe 评分（评分 1/2/3，n（%）：20（74）/4（15）/3（11）比 154（91）/7（4）/9（5），p=0.04）较高，但呼吸机撤机更早（p<0.001），28 天死亡率更好（p=0.043）。在调整了潜在混杂因素后，药物相关性 ARDS 组与较低的 28 天死亡率相关（调整后的 HR（HR）0.275；95%CI 0.106 至 0.711；p=0.008）。
尽管药物相关性 ARDS 患者的肺部损伤更严重，伴有纤维增生，但呼吸机撤机更早，预后更好。需要进一步设计良好的前瞻性研究。
