Dai Qingqing, Wang Sicong, Liu Ruijin, Wang Hongliang, Zheng Junbo, Yu Kaijiang
Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin 150081, China.
J Thorac Dis. 2019 Mar;11(3):673-685. doi: 10.21037/jtd.2019.02.84.
The determination of risk factors for acute respiratory distress syndrome (ARDS) patients remains a challenge. Our study aims to explore the epidemiology and risk factors affecting outcomes of ARDS patients and provide a theoretical basis for patients' prognosis.
This retrospective study included 207 ARDS patients admitted to the general intensive care unit (ICU) in the Second Affiliated Hospital of Harbin Medical University from Jan 1st, 2016 to Jan 1st, 2017. The criteria were defined according to the Berlin Definition, and clinical data were collected from the medical record system. The mortality rate and duration of mechanical ventilation were compared in ARDS patients. Furthermore, logistic regression analysis was applied to screen clinically accessible risk factors for survival and duration of mechanical ventilation.
The total mortality in ARDS patients was 39.13% (81/207) compared to 13.57% (151/1,113) in the whole ICU population. The period prevalence of mild, moderate and severe ARDS was 39.61% (82/207), 37.20% (77/207) and 23.19% (48/207), respectively. Logistic regression analysis showed that acute physiology and chronic health evaluation II (APACHE II) score (OR 3.4316; 95% CI: 1.3130-8.9686; P=0.0119), number of organ failure (OR 3.4928; 95% CI: 1.9775-6.1693; P<0.0001), mean arterial pressure (MAP) (OR 5.1049; 95% CI: 1.8317-14.2274; P=0.0018), driving pressure (OR 6.0017; 95% CI: 2.1746-16.5641; P=0.0005) and lactate level (OR 4.0754; 95% CI: 1.6114-10.3068; P=0.0030) were influence factors for survival; severity of ARDS (OR 1.6715; 95% CI: 1.0307-2.7108; P=0.0373), ventilator-associated pneumonia (VAP) (OR 7.3746; 95% CI: 2.9799-18.2505; P<0.0001) and transfusion history (OR 2.2822; 95% CI: 1.0462-4.9783; P=0.0381) were influence factors for duration of mechanical ventilation.
Higher APACHE II score, more organ failures, lower MAP, higher driving pressure and higher lactate level are risk factors for survival. Higher severity of ARDS, VAP and transfusion history are risk factors for prolonged duration of mechanical ventilation. Application of these parameters would enable intensivists to treat their patients more precisely and comprehensively.
确定急性呼吸窘迫综合征（ARDS）患者的危险因素仍然是一项挑战。我们的研究旨在探讨ARDS患者的流行病学及影响其预后的危险因素，为患者的预后提供理论依据。
这项回顾性研究纳入了2016年1月1日至2017年1月1日在哈尔滨医科大学附属第二医院综合重症监护病房（ICU）收治的207例ARDS患者。根据柏林定义确定标准，并从病历系统收集临床数据。比较ARDS患者的死亡率和机械通气时间。此外，应用逻辑回归分析筛选影响生存及机械通气时间的临床可获取危险因素。
ARDS患者的总死亡率为39.13%（81/207），而整个ICU人群的死亡率为13.57%（151/1113）。轻度、中度和重度ARDS的期间患病率分别为39.61%（82/207）、37.20%（77/207）和23.19%（48/207）。逻辑回归分析显示，急性生理与慢性健康状况评分II（APACHE II）（比值比[OR]3.4316；95%置信区间[CI]：1.3130 - 8.9686；P = 0.0119）、器官衰竭数量（OR 3.4928；95% CI：1.9775 - 6.1693；P < 0.0001）、平均动脉压（MAP）（OR 5.1049；95% CI：1.8317 - 14.2274；P = 0.0018）、驱动压（OR 6.0017；95% CI：2.1746 - 16.5641；P = 0.0005）和乳酸水平（OR 4.0754；95% CI：1.6114 - 10.3068；P = 0.0030）是生存的影响因素；ARDS严重程度（OR 1.6715；95% CI：1.0307 - 2.7108；P = 0.0373）、呼吸机相关性肺炎（VAP）（OR 7.3746；95% CI：2.9799 - 18.2505；P < 0.0001）和输血史（OR 2.2822；95% CI：1.0462 - 4.9783；P = 0.0381）是机械通气时间的影响因素。
较高的APACHE II评分、更多的器官衰竭、较低的MAP、较高的驱动压和较高的乳酸水平是生存的危险因素。较高的ARDS严重程度、VAP和输血史是机械通气时间延长的危险因素。应用这些参数将使重症监护医生能够更精确、全面地治疗患者。
