Si Xiaoqian, Zhao Xiujuan, Zhu Fengxue, Wang Tianbing
Department of Critical Care Medicine, Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China.
Peking University School of Basic Medical Sciences, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Apr 18;56(2):307-312. doi: 10.19723/j.issn.1671-167X.2024.02.016.
To investigate the risk factors of acute respiratory distress syndrome (ARDS) after traumatic hemorrhagic shock.
This was a retrospective cohort study of 314 patients with traumatic hemorrhagic shock at Trauma Medicine Center, Peking University People's Hospital from December 2012 to August 2021, including 152 male patients and 162 female patients, with a median age of 63.00 (49.75-82.00) years. The demographic data, past medical history, injury assessment, vital signs, laboratory examination and other indicators of these patients during hospitalization were recorded. These patients were divided into two groups, ARDS group (=89) and non-ARDS group (=225) according to whether there was ARDS within 7 d of admission. Risk factors for ARDS were identified using Logistic regression. The C-statistic expressed as a percentage [area under curve (AUC) of the receiver operating characteristic (ROC) curve] was used to assess the discrimination of the model.
The incidence of ARDS after traumatic hemorrhagic shock was 28.34%. Finally, Logistic regression model showed that the independent risk factors of ARDS after traumatic hemorrhagic shock included male, history of coronary heart disease, high acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, road traffic accident and elevated troponin Ⅰ. The and 95% confidence intervals () were 4.01 (95%: 1.75-9.20), 5.22 (95%: 1.29-21.08), 1.07 (95%: 1.02-1.57), 2.53 (95%: 1.21-5.28), and 1.26 (95%: 1.02-1.57), respectively; the values were 0.001, 0.020, 0.009, 0.014, and 0.034, respectively. The ROC curve was used to analyze the value of each risk factor in predicting ARDS. It was found that the AUC for predicting ARDS after traumatic hemorrhagic shock was 0.59 (95%: 0.51-0.68) for male, 0.55 (95%: 0.46-0.64) for history of coronary heart disease, 0.65 (95%: 0.57-0.73) for APACHE Ⅱ score, 0.58 (95%: 0.50-0.67) for road traffic accident, and 0.73 (95%: 0.66-0.80) for elevated troponin Ⅰ, with an overall predictive value of 0.81 (95%: 0.74-0.88).
The incidence of ARDS in patients with traumatic hemorrhagic shock is high, and male, history of coronary heart disease, high APACHE Ⅱ score, road traffic accident and elevated troponin Ⅰ are independent risk factors for ARDS after traumatic hemorrhagic shock. Timely monitoring these indicators is conducive to early detection and treatment of ARDS after traumatic hemorrhagic shock.
探讨创伤失血性休克后急性呼吸窘迫综合征（ARDS）的危险因素。
这是一项对2012年12月至2021年8月北京大学人民医院创伤医学中心314例创伤失血性休克患者的回顾性队列研究，其中男性患者152例，女性患者162例，中位年龄为63.00（49.75 - 82.00）岁。记录这些患者住院期间的人口统计学数据、既往病史、损伤评估、生命体征、实验室检查及其他指标。根据入院7 d内是否发生ARDS将这些患者分为两组，即ARDS组（n = 89）和非ARDS组（n = 225）。采用Logistic回归分析确定ARDS的危险因素。用C统计量[以受试者工作特征（ROC）曲线下面积（AUC）表示的百分比]评估模型的判别能力。
创伤失血性休克后ARDS的发生率为28.34%。最终，Logistic回归模型显示创伤失血性休克后ARDS的独立危险因素包括男性、冠心病史、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）升高、道路交通事故及肌钙蛋白Ⅰ升高。比值比（OR）及95%置信区间（CI）分别为4.01（95%：1.75 - 9.20）、5.22（95%：1.29 - 21.08）、1.07（95%：1.02 - 1.57）、2.53（95%：1.21 - 5.28）和1.26（95%：1.02 - 1.57）；P值分别为0.001、0.020、0.009、0.014和0.034。用ROC曲线分析各危险因素预测ARDS的价值。结果发现，男性预测创伤失血性休克后ARDS的AUC为0.59（95%：0.51 -
