青海西宁高原地区急性呼吸窘迫综合征的定义：柏林定义海拔 - 动脉血氧分压/吸入氧分数值校正标准的验证
Definition of Acute Respiratory Distress Syndrome on the Plateau of Xining, Qinghai: A Verification of the Berlin Definition Altitude-PaO/FiO-Corrected Criteria.
作者信息
Liu Xiaoqin, Pan Chun, Si Lining, Tong Shijun, Niu Yi, Qiu Haibo, Gan Guifen
机构信息
Department of Critical Care Medicine, Affiliated Hospital of Qinghai University, Xining, China.
Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
出版信息
Front Med (Lausanne). 2022 Feb 23;9:648835. doi: 10.3389/fmed.2022.648835. eCollection 2022.
BACKGROUND
Acute respiratory distress syndrome (ARDS) is a common critical respiratory illness. Hypoxia at high altitude is a factor that influences the progression of ARDS. Currently, we lack clear diagnostic criteria for high-altitude ARDS. The purpose of this study was to determine the value of the application of the Berlin Definition altitude-PaO/FiO-corrected criteria for ARDS in Xining, Qinghai (2,261 m).
METHODS
We retrospectively analyzed the clinical data of patients with ARDS admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Qinghai University from January 2018 to December 2018. The severity of ARDS was categorized according to the Berlin Definition, Berlin Definition altitude-PaO/FiO-corrected criteria, and the diagnostic criteria for acute lung injury (ALI)/ARDS at high altitudes in Western China (Zhang criteria). In addition, the differences between the three criteria were compared.
RESULTS
Among 1,221 patients, 512 were treated with mechanical ventilation. In addition, 253 met the Berlin Definition, including 49 (19.77%) with mild ARDS, 148 (58.50%) with moderate ARDS, and 56 (22.13%) with severe ARDS. A total of 229 patients met the altitude-PaO/FiO-corrected criteria, including 107 with mild ARDS (46.72%), 84 with moderate ARDS (36.68%), and 38 (16.59%) with severe ARDS. Intensive care unit (ICU) mortality increased with the severity of ARDS (mild, 17.76%; moderate, 21.43%; and severe, 47.37%). Twenty-eight-day mortality increased with worsening ARDS (mild 23.36% vs. moderate 44.05% vs. severe 63.16%) ( < 0.001). There were 204 patients who met the Zhang criteria, including 87 (42.65%) with acute lung injury and 117 (57.35%) with ARDS. The area under receiver operating characteristics (AUROCs) of the Berlin Definition, the altitude-P/F-corrected criteria, and the Zhang criteria were 0.6675 (95% CI 0.5866-0.7484), 0.6216 (95% CI 0.5317-0.7116), and 0.6050 (95% CI 0.5084-0.7016), respectively. There were no statistically significant differences between the three diagnostic criteria.
CONCLUSION
For Xining, Qinghai, the altitude-PaO/FiO-corrected criteria for ARDS can distinguish the severity of ARDS, but these results need to be confirmed in a larger sample and in multicenter clinical studies.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier: NCT04199650.
背景
急性呼吸窘迫综合征（ARDS）是一种常见的严重呼吸系统疾病。高原地区缺氧是影响ARDS病情进展的一个因素。目前，我们缺乏针对高原地区ARDS的明确诊断标准。本研究的目的是确定柏林定义海拔 - PaO₂/FiO₂校正标准在青海西宁（海拔2261米）应用于ARDS的价值。
方法
我们回顾性分析了2018年1月至2018年12月在青海大学附属医院重症医学科收治的ARDS患者的临床资料。根据柏林定义、柏林定义海拔 - PaO₂/FiO₂校正标准以及中国西部高原地区急性肺损伤（ALI）/ARDS诊断标准（张标准）对ARDS的严重程度进行分类。此外，比较了这三种标准之间的差异。
结果
在1221例患者中，512例接受了机械通气治疗。另外，253例符合柏林定义，其中轻度ARDS 49例（19.77%），中度ARDS 148例（58.50%），重度ARDS 56例（22.13%）。共有229例患者符合海拔 - PaO₂/FiO₂校正标准，其中轻度ARDS 107例（46.72%），中度ARDS 84例（36.68%），重度ARDS 38例（16.59%）。重症监护病房（ICU）死亡率随ARDS严重程度增加（轻度为17.76%；中度为21.43%；重度为47.37%）。28天死亡率随ARDS病情加重而增加（轻度23.36%，中度44.05%，重度63.16%）（P < 0.001）。有204例患者符合张标准，其中急性肺损伤87例（42.65%），ARDS 117例（57.35%）。柏林定义、海拔 - P/F校正标准和张标准的受试者工作特征曲线下面积（AUROCs）分别为0.6675（95%CI 0.5866 - 0.7484）、0.6216（95%CI 0.5317 - 0.7116）和0.6050（95%CI 0.5084 - 0.7016）。这三种诊断标准之间无统计学显著差异。
结论
对于青海西宁地区，ARDS的海拔 - PaO₂/FiO₂校正标准能够区分ARDS的严重程度，但这些结果需要在更大样本和多中心临床研究中得到证实。
临床试验注册
ClinicalTrials.gov，标识符：NCT04199650。
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