肝硬化机械通气患者急性呼吸窘迫综合征的结局
Outcomes of Acute Respiratory Distress Syndrome in Mechanically Ventilated Patients With Cirrhosis.
作者信息
Boente Ryan D, Sheikh Adil, Bosslet Gabriel T, Ghabril Marwan S
机构信息
Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University, Indianapolis, Indiana.
Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University, Indianapolis, Indiana.
出版信息
Crit Care Explor. 2019 Sep 17;1(9):e0040. doi: 10.1097/CCE.0000000000000040. eCollection 2019 Sep.
UNLABELLED
To better describe the outcomes of acute respiratory distress syndrome in mechanically ventilated patients with cirrhosis.
DESIGN
Single-center, retrospective study of mechanically ventilated patients with cirrhosis between 2008 and 2015.
SETTING
ICU at a large academic medical and transplant center.
PATIENTS
One hundred eighty-one mechanically ventilated patients with cirrhosis.
INTERVENTIONS
Demographic and clinical data were reviewed, and acute respiratory distress syndrome was identified per Berlin criteria. We compared demographic and clinical characteristics on ICU admission in patients with and without acute respiratory distress syndrome. The primary endpoint was hospital mortality (including discharge to hospice). Mortality risk was stratified by Chronic Liver Failure-Sequential Organ Failure Assessment and Model for End-Stage Liver Disease.
MEASUREMENTS AND MAIN RESULTS
The mean age in 181 eligible patients was 53 ± 11 years; 67% were male; and 91% were Caucasian. In all, = 35 (19%) of mechanically ventilated patients had acute respiratory distress syndrome. They were more frequently female (46% vs 30%; = 0.08), with suspected infection (86% vs 53%; < 0.001), and had higher mean Model for End-Stage Liver Disease (32 vs 24; < 0.001) and Chronic Liver Failure-Sequential Organ Failure Assessment (15 vs 11; < 0.001) than patients without acute respiratory distress syndrome. Hospital mortality was higher in patients with (40%) versus without (22%) acute respiratory distress syndrome ( = 0.03). In the risk-adjusted analysis (for Model for End-Stage Liver Disease, Chronic Liver Failure-Sequential Organ Failure Assessment and age), acute respiratory distress syndrome was not independently associated with hospital mortality (odds ratio, 0.80; CI, 0.3-2.5; = 0.7).
CONCLUSIONS
Acute respiratory distress syndrome is common in mechanically ventilated patients with cirrhosis but is not independently associated with increased mortality.
未加标注
为了更好地描述肝硬化机械通气患者急性呼吸窘迫综合征的结局。
设计
对2008年至2015年间肝硬化机械通气患者进行的单中心回顾性研究。
背景
一家大型学术医疗和移植中心的重症监护病房。
患者
181例肝硬化机械通气患者。
干预措施
回顾人口统计学和临床数据，并根据柏林标准确定急性呼吸窘迫综合征。我们比较了有和没有急性呼吸窘迫综合征的患者入住重症监护病房时的人口统计学和临床特征。主要终点是医院死亡率（包括出院至临终关怀机构）。通过慢性肝功能衰竭-序贯器官衰竭评估和终末期肝病模型对死亡风险进行分层。
测量指标和主要结果
181例符合条件的患者的平均年龄为53±11岁；67%为男性；91%为白种人。总共有35例（19%）机械通气患者发生急性呼吸窘迫综合征。她们女性比例更高（46%对30%；P=0.08），疑似感染比例更高（86%对53%；P<0.001），终末期肝病模型平均得分更高（32对24；P<0.001），慢性肝功能衰竭-序贯器官衰竭评估得分更高（15对11；P<0.001），均高于没有急性呼吸窘迫综合征的患者。有急性呼吸窘迫综合征的患者医院死亡率（40%）高于没有该综合征的患者（22%）（P=0.03）。在风险调整分析中（针对终末期肝病模型、慢性肝功能衰竭-序贯器官衰竭评估和年龄），急性呼吸窘迫综合征与医院死亡率无独立相关性（比值比，0.80；可信区间，0.3-2.5；P=0.7）。
结论
急性呼吸窘迫综合征在肝硬化机械通气患者中很常见，但与死亡率增加无独立相关性。
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