Burn and Shock Trauma Research Institute, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, IL.
Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL.
Ann Surg. 2019 Dec;270(6):1186-1193. doi: 10.1097/SLA.0000000000002795.
To derive and validate a prediction model for the development of ARDS in burn-injured patients.
Burn injury carries the highest incidence of acute respiratory distress syndrome (ARDS) among all predisposing conditions, but few studies exist on risk factors in these patients. Studies employing biomarkers and clinical risk factors for predicting ARDS mortality have recently been examined but none exist for onset of ARDS nor in patients with burn injury.
This was a prospective multicenter study of 113 patients with isolated burn injury or inhalation injury. Clinical variables and plasma biomarkers representative of endothelial injury, epithelial injury, or inflammation were collected within 24 hours of admission. The most parsimonious model was chosen by considering discrimination, calibration, and model fit.
Among the biomarkers measured in patients with burn injuries, a one-standard deviation increase in log-transformed levels of the A2 domain of von Willebrand factor in the first 24 hours was most strongly associated with the development of ARDS (OR 7.72; 95% CI: 1.64-36.28, P = 0.03). Of candidate models, a 3-variable model with %TBSA, inhalation injury, and von Willebrand factor-A2 had comparable discrimination to more complex models (area under the curve: 0.90; 95% CI 0.85-0.96). The 3-variable model had good model fit by Hosmer-Lemeshow test (P = 0.74) and maintained similar discrimination after accounting for performance optimism (Bootstrapped area under the curve: 0.90; 95% CI: 0.84-0.95).
The 3-variable model with %TBSA, inhalation injury, and von Willebrand factor could be used to better identify at-risk patients for both the study and prevention of ARDS in patients with burn injury.
建立并验证预测烧伤患者发生急性呼吸窘迫综合征（ARDS）的模型。
在所有诱发因素中，烧伤导致急性呼吸窘迫综合征（ARDS）的发生率最高，但针对此类患者的危险因素研究甚少。最近已经有研究采用生物标志物和临床危险因素来预测 ARDS 死亡率，但尚无研究针对 ARDS 发病或烧伤患者。
这是一项针对 113 例单纯烧伤或吸入性损伤患者的前瞻性多中心研究。患者入院后 24 小时内采集临床变量和代表血管内皮损伤、上皮损伤或炎症的血浆生物标志物。通过考虑判别、校准和模型拟合，选择最简约的模型。
在烧伤患者中测量的生物标志物中，伤后 24 小时内 von Willebrand 因子 A2 结构域的对数转换水平增加一个标准差与 ARDS 的发生最密切相关（OR 7.72；95%CI：1.64-36.28，P = 0.03）。在候选模型中，%TBSA、吸入性损伤和 von Willebrand 因子 A2 的 3 变量模型与更复杂的模型具有相当的判别能力（曲线下面积：0.90；95%CI 0.85-0.96）。Hosmer-Lemeshow 检验表明 3 变量模型拟合良好（P = 0.74），并且在考虑到性能乐观性后，其判别能力保持不变（Bootstrapped 曲线下面积：0.90；95%CI：0.84-0.95）。
%TBSA、吸入性损伤和 von Willebrand 因子的 3 变量模型可用于更好地识别烧伤患者发生 ARDS 的高危人群，从而对其进行研究并预防 ARDS。
