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三级医疗环境中影响急性呼吸窘迫综合征患者预后的因素。

Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting.

作者信息

Rashid Muhammed, Ramakrishnan Manasvini, Muthu Deepa Sudalai, Chandran Viji Pulikkel, Thunga Girish, Kunhikatta Vijayanarayana, Shanbhag Vishal, Acharya Raviraja V, Nair Sreedharan

机构信息

Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India.

Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.

出版信息

Clin Epidemiol Glob Health. 2022 Jan-Feb;13:100972. doi: 10.1016/j.cegh.2022.100972. Epub 2022 Jan 18.

Abstract

PURPOSE

The clinical profile and factors affecting outcomes in acute respiratory distress syndrome (ARDS) from adequately sample-sized Indian studies are still lacking. We aimed to investigate the clinical profile, treatment pattern, outcomes; and to assess factors affecting non-recovery in ARDS patients.

PATIENTS AND METHODS

A retrospective observational study was conducted among adult ARDS patients admitted during five year period (January 2014-December 2018) in a South Indian tertiary care setting. The relevant data were collected from the medical records to the data collection form. The univariate and multivariate logistic regression analyses were conducted to identify the predictors of outcomes using SPSS v20.

RESULTS

A total of 857 participants including 496 males and 361 females with a mean age of 46.86 ± 15.81 years were included in this study. Fever (70.9%), crepitation (58.3%), breathlessness (56.9%), and cough (45%) were the major clinical presentation. Hypertension (25.2%), kidney disease (23.8%), and diabetes (22.3%) were the major comorbidities; and sepsis (37.6%), pneumonia (33.3%), and septic shock (27.5%) were the major etiological factors observed. Antibiotics and steroids were administered to 97.9% and 52.3% of the population, respectively. The recovery rate was 47.49%. The patients with scrub typhus, dengue, pancreatitis, and oxygen supplementation had significantly lower mortality. The factors such as advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were observed to be the independent predictors of non-recovery in ARDS patients.

CONCLUSION

A comparable recovery rate was observed in our population. Advanced age, sepsis, septic shock, liver diseases, and ventilation requirements were the independent predictors of non-recovery.

摘要

目的

目前仍缺乏来自印度的足够样本量研究中急性呼吸窘迫综合征(ARDS)的临床特征及影响预后的因素。我们旨在调查ARDS患者的临床特征、治疗模式、预后;并评估影响ARDS患者未康复的因素。

患者与方法

在印度南部一家三级医疗机构对2014年1月至2018年12月这五年期间收治的成年ARDS患者进行了一项回顾性观察研究。从病历中收集相关数据并录入数据收集表。使用SPSS v20进行单因素和多因素逻辑回归分析以确定预后的预测因素。

结果

本研究共纳入857名参与者,其中男性496名,女性361名,平均年龄为46.86±15.81岁。主要临床表现为发热(70.9%)、捻发音(58.3%)、呼吸困难(56.9%)和咳嗽(45%)。主要合并症为高血压(25.2%)、肾脏疾病(23.8%)和糖尿病(22.3%);观察到的主要病因是脓毒症(37.6%)、肺炎(33.3%)和感染性休克(27.5%)。分别有97.9%和52.3%的患者使用了抗生素和类固醇。康复率为47.49%。恙虫病、登革热、胰腺炎患者以及接受氧疗的患者死亡率显著较低。观察到高龄、脓毒症、感染性休克、肝脏疾病和通气需求等因素是ARDS患者未康复的独立预测因素。

结论

我们的研究人群中观察到了相当的康复率。高龄、脓毒症、感染性休克、肝脏疾病和通气需求是未康复的独立预测因素。

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