小儿肿瘤患者肺急性呼吸窘迫综合征诊断后24小时氧合状态与30天死亡率之间的关联
The Association Between Oxygenation Status at 24 h After Diagnosis of Pulmonary Acute Respiratory Distress Syndrome and the 30-Day Mortality among Pediatric Oncological Patients.
作者信息
Huang Xueqiong, Xu Lingling, Pei Yuxin, Huang Huimin, Chen Chao, Tang Wen, Jiang Xiaoyun, Li Yijuan
机构信息
Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
Front Pediatr. 2022 May 11;10:805264. doi: 10.3389/fped.2022.805264. eCollection 2022.
BACKGROUND
Pediatric oncology patients with acute respiratory distress syndrome (ARDS) secondary to pneumonia are at high risk of mortality. Our aim was to describe the epidemiology of ARDS in this clinical population and to identify the association between the oxygenation status at 24 h after diagnosis and the 30-day mortality rates, stratified by the severity of ARDS.
METHODS
This was a retrospective cohort study of 82 pediatric oncology patients, with a median age of 4 years, admitted to our pediatric intensive care unit with a diagnosis of ARDS between 2013 and 2021. Demographic and clinical factors were compared between the survivor ( = 52) and non-survivor ( = 30) groups. Univariate and multivariate Cox proportional hazards regression models were used to determine the association between the oxygenation status at 24 h after diagnosis and the 30-day mortality rates.
RESULTS
The mean airway pressure at ARDS diagnosis, PaO/FiO (P/F) ratio, oxygenation index (OI) value, peak inspiratory pressure, and lactate level at 24 h after ARDS diagnosis, as well as complications (i.e., septicemia and more than two extrapulmonary organ failures) and adjunctive continuous renal replacement therapy, were significant mortality risk factors. After adjusting for other covariates, the oxygenation status P/F ratio (Hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.96-1.00, = 0.043) and OI value (HR = 1.12, 95% CI = 1.02-1.23, = 0.016) at 24 h remained independent mortality risk factors. According to the Kaplan-Meier survival curve, a low P/F ratio (≤ 150) and high OI (>10) were associated with a higher risk of 30-day mortality (50.9 and 52.9%, respectively; both < 0.05).
CONCLUSION
The P/F ratio and OI value measured at 24 h after ARDS diagnosis can provide a better stratification of patients according to ARDS disease severity to predict the 30-day mortality risk.
背景
因肺炎继发急性呼吸窘迫综合征（ARDS）的儿科肿瘤患者死亡风险很高。我们的目的是描述这一临床人群中ARDS的流行病学特征，并确定诊断后24小时的氧合状态与30天死亡率之间的关联，按ARDS严重程度分层。
方法
这是一项对82例儿科肿瘤患者的回顾性队列研究，这些患者年龄中位数为4岁，于2013年至2021年期间因ARDS诊断入住我们的儿科重症监护病房。对存活者（n = 52）和非存活者（n = 30）组的人口统计学和临床因素进行了比较。使用单变量和多变量Cox比例风险回归模型来确定诊断后24小时的氧合状态与30天死亡率之间的关联。
结果
ARDS诊断时的平均气道压力、动脉血氧分压/吸入氧分数值（PaO₂/FiO₂，P/F）、氧合指数（OI）值、峰值吸气压力以及ARDS诊断后24小时的乳酸水平，还有并发症（即败血症和两个以上肺外器官功能衰竭）和辅助性连续性肾脏替代治疗，均为显著的死亡风险因素。在对其他协变量进行调整后，诊断后24小时的氧合状态P/F比值（风险比[HR]=0.98，95%置信区间[CI]=0.96 - 1.00，P = 0.043）和OI值（HR = 1.12，95% CI = 1.02 - 1.23，P = 0.016）仍然是独立的死亡风险因素。根据Kaplan-Meier生存曲线，低P/F比值（≤150）和高OI值（>10）与30天死亡风险较高相关（分别为50.9%和52.9%；P均<0.05）。
结论
ARDS诊断后24小时测得的P/F比值和OI值可根据ARDS疾病严重程度对患者进行更好的分层，以预测30天死亡风险。
Zotero 插件