Engelhardt Lilian Jo, Olbricht Claudio, Niemann Marcel, Graw Jan Adriaan, Hunsicker Oliver, Weiss Björn, Bünger Victoria, Weber-Carstens Steffen, Boie Sebastian Daniel, Piper Sophie K, Balzer Felix, Menk Mario
Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
J Clin Med. 2022 Sep 28;11(19):5734. doi: 10.3390/jcm11195734.
(1) Background: Acute respiratory distress syndrome (ARDS) is a rare complication in multiply injured patients. Due to the rarity of ARDS development after trauma, little is known about outcomes of patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. (2) Methods: This retrospective analysis included = 1038 ARDS patients admitted to the ARDS center of Charité-Universitätsmedizin Berlin between 2007 and 2018. Patients with trauma-associated ARDS ( = 62) were compared to patients with non-trauma-associated ARDS ( = 976). In a secondary analysis, patients from the group with non-trauma-associated ARDS were 1:1 nearest neighbor matched to patients with trauma-associated ARDS. The primary outcomes were 28-day in-hospital mortality, 60-day in-hospital mortality, and overall in-hospital mortality. (3) Results: Overall in-hospital mortality in trauma-associated ARDS was 29.0% compared to 40.5% in all patients with non-trauma-associated ARDS ( = 0.074). The in-hospital mortality rate in matched patients with non-trauma-associated ARDS (33.9%) was comparable to the trauma-associated ARDS cohort ( = 0.701). Kaplan-Meier curves indicated time-sensitive variations in 28-day and 60-day in-hospital survival. (4) Conclusion: Mortality was not different in patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. Survival rate in the Kaplan-Meier curves stabilized after the critical initial phase and throughout the further 60-day period in patients with trauma-associated ARDS compared to patients with non-trauma-associated ARDS. Since this divergence was less pronounced in the matched cohort, it may be related to the younger age, fewer comorbidities, and lower ARDS severity in patients with trauma-associated ARDS. Patients with trauma-associated ARDS remain a very different cohort compared to patients with non-trauma-associated ARDS. Therefore, the outcome comparison is limited, even after matching.
（1）背景：急性呼吸窘迫综合征（ARDS）是多发伤患者中一种罕见的并发症。由于创伤后发生ARDS的情况罕见，与非创伤相关性ARDS患者相比，创伤相关性ARDS患者的预后鲜为人知。（2）方法：这项回顾性分析纳入了2007年至2018年间在柏林夏里特大学医学中心ARDS中心收治的1038例ARDS患者。将创伤相关性ARDS患者（n = 62）与非创伤相关性ARDS患者（n = 976）进行比较。在二次分析中，将非创伤相关性ARDS组的患者与创伤相关性ARDS患者进行1:1最近邻匹配。主要结局指标为28天住院死亡率、60天住院死亡率和总体住院死亡率。（3）结果：创伤相关性ARDS患者的总体住院死亡率为29.0%，而非创伤相关性ARDS患者的总体住院死亡率为40.5%（P = 0.074）。匹配的非创伤相关性ARDS患者的住院死亡率（33.9%）与创伤相关性ARDS队列相当（P = 0.701）。Kaplan-Meier曲线显示28天和60天住院生存率存在时间敏感性差异。（4）结论：与非创伤相关性ARDS患者相比，创伤相关性ARDS患者的死亡率并无差异。与非创伤相关性ARDS患者相比，创伤相关性ARDS患者在关键的初始阶段后以及随后的60天内，Kaplan-Meier曲线中的生存率趋于稳定。由于这种差异在匹配队列中不太明显，可能与创伤相关性ARDS患者年龄较小、合并症较少以及ARDS严重程度较低有关。与非创伤相关性ARDS患者相比，创伤相关性ARDS患者仍然是一个非常不同的队列。因此，即使经过匹配，结局比较也受到限制。
