Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, 160-8582, Japan.
Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan.
BMC Pulm Med. 2019 Feb 11;19(1):37. doi: 10.1186/s12890-019-0803-0.
In the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients.
In this study, we examined the associations between the Berlin definition criteria and prognosis and clinical parameters, including high-resolution computed tomography (HRCT) scores of fibroproliferative changes of the lungs. One hundred fifty-three patients (45 females; mean age, 67 y/o), who met the Berlin definition and received treatment in our intensive care unit between January 2012 and December 2015, were enrolled.
The severity of ARDS was mild in 42 patients, moderate in 71, and severe in 40. The underlying diseases included pneumonia in 56 patients and aspiration in 43. Forty-two (27.5%) patients were deceased within 30 days, and the 30-day mortality was 10% in mild ARDS, 23% in moderate, and 55% in severe, which were significantly different (P < 0.05). In the non-survivors, APACHE II, SOFA, and SAPS II scores were higher than in the survivors (P < 0.001). Multivariate analyses revealed that elevated blood lactate level (≥ 2.0 mmol/L) and increased HRCT scores were significantly associated with weaning failure and 30-day mortality of the patients with ARDS.
These results suggested that the severity criteria in the Berlin definition might be associated with the prognosis of the patients. Blood lactate levels and HRCT score might be predictive of the outcome of patients with ARDS.
根据柏林定义，急性呼吸窘迫综合征（ARDS）根据发病时的氧合严重程度分为三个阶段。ARDS 严重程度与预后之间的关系在已发表的报告中存在差异，尚未得到验证，尤其是在亚洲患者中。
本研究中，我们检查了柏林定义标准与预后以及包括肺部纤维增殖性变化的高分辨率计算机断层扫描（HRCT）评分在内的临床参数之间的关联。2012 年 1 月至 2015 年 12 月期间，我们在重症监护病房收治了符合柏林定义并接受治疗的 153 名患者（45 名女性；平均年龄 67 岁）。
ARDS 的严重程度为轻度 42 例，中度 71 例，重度 40 例。基础疾病包括肺炎 56 例，吸入性肺炎 43 例。42 例（27.5%）患者在 30 天内死亡，轻度 ARDS、中度 ARDS 和重度 ARDS 的 30 天死亡率分别为 10%、23%和 55%，差异有统计学意义（P<0.05）。在非幸存者中，APACHE II、SOFA 和 SAPS II 评分均高于幸存者（P<0.001）。多变量分析显示，血乳酸水平升高（≥2.0mmol/L）和 HRCT 评分增加与 ARDS 患者撤机失败和 30 天死亡率显著相关。
这些结果表明，柏林定义中的严重程度标准可能与患者的预后相关。血乳酸水平和 HRCT 评分可能是预测 ARDS 患者结局的指标。
