一种改良的急性呼吸窘迫综合征预测评分：中国的一项多中心队列研究
A modified acute respiratory distress syndrome prediction score: a multicenter cohort study in China.
作者信息
Xie Jianfeng, Liu Ling, Yang Yi, Yu Wenkui, Li Maoqin, Yu Kaijiang, Zheng Ruiqiang, Yan Jie, Wang Xue, Cai Guolong, Li Jianguo, Gu Qin, Zhao Hongsheng, Mu Xinwei, Ma Xiaochun, Qiu Haibo
机构信息
Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China.
Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
出版信息
J Thorac Dis. 2018 Oct;10(10):5764-5773. doi: 10.21037/jtd.2018.09.117.
BACKGROUND
Early recognition of the risks of acute respiratory distress syndrome (ARDS) and prevention of the development of ARDS may be more effective in improving patient outcomes. We performed the present study to determine the ARDS risk factors in a Chinese population and validate a score to predict the development of ARDS.
METHODS
This was an observational multicenter cohort study performed in 13 tertiary hospitals in China. Patients admitted into participating intensive care units (ICUs) from January 1 to January 31, 2012, and from January 1 to January 10, 2013, were enrolled in a retrospective derivation cohort and a prospective validation cohort, respectively. In the derivation cohort, the potential risk factors of ARDS were collected. The confirmed risk factors were determined with univariate and multivariate logistic regression analyses, and then the modified ARDS prediction score (MAPS) was established. We prospectively enrolled patients to verify the accuracy of MAPS.
RESULTS
A total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 [95% confidence interval (CI), 0.758-0.859, P<0.001]. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717-0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728-0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046).
CONCLUSIONS
The MAPS based on risk factors could help the clinician to predict patients who will develop ARDS.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01666834.
背景
早期识别急性呼吸窘迫综合征（ARDS）的风险并预防ARDS的发生可能对改善患者预后更有效。我们开展本研究以确定中国人群中ARDS的危险因素，并验证一个预测ARDS发生的评分。
方法
这是一项在中国13家三级医院进行的观察性多中心队列研究。分别于2012年1月1日至1月31日以及2013年1月1日至1月10日入住参与研究的重症监护病房（ICU）的患者被纳入回顾性推导队列和前瞻性验证队列。在推导队列中，收集ARDS的潜在危险因素。通过单因素和多因素逻辑回归分析确定确诊的危险因素，然后建立改良的ARDS预测评分（MAPS）。我们前瞻性纳入患者以验证MAPS的准确性。
结果
分别有479例和198例患者被纳入回顾性推导队列和前瞻性验证队列。推导队列中共有93例（19.4%）患者发生ARDS。急性胰腺炎、肺炎、低白蛋白血症、酸中毒和高呼吸频率是ARDS的危险因素。MAPS能够区分发生ARDS的患者和未发生ARDS的患者，曲线下面积（AUC）为0.809 [95%置信区间（CI），0.758 - 0.859，P<0.001]。在前瞻性验证队列中，MAPS的表现与回顾性推导队列相似，AUC为0.792（95% CI，0.717 - 0.867，P<0.001）。肺损伤预测评分（LIPS）在我们的患者中的预测AUC值为0.770（95% CI，0.728 - 0.812，P<0.001），显著低于我们的评分（P<0.046）。
结论
基于危险因素的MAPS有助于临床医生预测发生ARDS的患者。
试验注册
ClinicalTrials.gov NCT01666834。
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