Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan road, Beijing 100043, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China.
Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, No. 5 Jingyuan road, Beijing 100043, China; Beijing Institute of Respiratory Medicine, Beijing 100020, China; The Clinical Research Center, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China.
Heart Lung. 2021 Jan-Feb;50(1):206-213. doi: 10.1016/j.hrtlng.2020.09.019. Epub 2020 Oct 14.
High density lipoprotein-cholesterol (HDL-C) concentration decreases in septic patients and the low level of HDL-C is associated with poor prognosis. However, no study has yet analyzed its prognostic implication specifically in pneumonia-ARDS cohort.
To evaluate the prognostic value of HDL-C levels in ARDS patients secondary to bacterial and viral pneumonia.
This was a retrospective observational study on 108 pneumonia-ARDS patients in RICU from 2017 to 2019. These patients were stratified into bacterial ARDS group (56) and viral ARDS group (52). The primary outcome was the association between HDL-C levels and 28-day mortality.
HDL-C levels were statistically lower in bacterial ARDS patients than those in viral ARDS patients (p<0.001). There were statistic negative correlations between HDL-C and APACHE II/SOFA score in bacterial ARDS patients (r=-0.284, p = 0.034 and r=-0.369, p = 0.005), but not in viral ARDS patients (r=-0.103, p = 0.469 and r=-0.225, p = 0.108). ROC analysis demonstrated that HDL-C had superior prediction value for 28-day mortality and identified HDL-C < 0.42 mmol/L was significantly associated with adverse outcomes in bacterial ARDS patients. The low HDL-C was an independent risk factor for death of bacterial ARDS patients (OR 0.027, 95% CI [0.001-0.905], P = 0.044).
HDL-C might be a valuable marker to assess the 28-d mortality for bacterial ARDS patients rather than viral ARDS patients.
脓毒症患者的高密度脂蛋白胆固醇（HDL-C）浓度降低，而低水平的 HDL-C 与预后不良相关。然而，尚无研究专门分析其在肺炎合并急性呼吸窘迫综合征（ARDS）患者中的预后意义。
评估 HDL-C 水平在细菌性和病毒性肺炎继发 ARDS 患者中的预后价值。
这是一项回顾性观察研究，纳入了 2017 年至 2019 年期间在重症监护病房（RICU）接受治疗的 108 例肺炎合并 ARDS 患者。这些患者分为细菌性 ARDS 组（56 例）和病毒性 ARDS 组（52 例）。主要结局是 HDL-C 水平与 28 天死亡率之间的关系。
与病毒性 ARDS 患者相比，细菌性 ARDS 患者的 HDL-C 水平显著降低（p<0.001）。在细菌性 ARDS 患者中，HDL-C 与急性生理学和慢性健康状况评分系统 II（APACHE II）/序贯器官衰竭评估（SOFA）评分呈负相关（r=-0.284，p=0.034 和 r=-0.369，p=0.005），但在病毒性 ARDS 患者中无此相关性（r=-0.103，p=0.469 和 r=-0.225，p=0.108）。ROC 分析表明，HDL-C 对 28 天死亡率有较好的预测价值，并确定 HDL-C<0.42mmol/L 与细菌性 ARDS 患者的不良结局显著相关。低 HDL-C 是细菌性 ARDS 患者死亡的独立危险因素（OR 0.027，95%CI [0.001-0.905]，P=0.044）。
HDL-C 可能是评估细菌性 ARDS 患者 28 天死亡率的有价值标志物，而不是病毒性 ARDS 患者。
