Yin Rui, Yang Xiaoshan, Yao Yanfen
Department of Critical Care Medicine, Binzhou People's Hospital, Binzhou, Shandong, China.
Department Rheumatology and Immunology, Binzhou People's Hospital, Binzhou, Shandong, China.
Heliyon. 2024 Sep 2;10(18):e37336. doi: 10.1016/j.heliyon.2024.e37336. eCollection 2024 Sep 30.
Acute Respiratory Distress Syndrome (ARDS) is a critical complication of sepsis, associated with high morbidity and mortality. Identifying risk factors for ARDS among sepsis patients is essential for early intervention and improving outcomes.
We conducted a comprehensive meta-analysis, reviewing studies that examined the association between various risk factors and ARDS development in sepsis patients. Databases such as PubMed, EMBASE, Cochrane Library, Medline, CINAHL, and Web of Science were searched up to January 2024, without language restrictions. Eligible studies included observational cohorts and case-control studies. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated using a random-effects model. Heterogeneity was assessed through I statistics, and publication bias was evaluated via the Luis Furuya-Kanamori (LFK) index.
15 studies with more than 40,000 participants were analyzed. Significant risk factors for ARDS included pulmonary infection (OR: 2.696, 95 % CI: 1.655 to 4.390), septic shock (OR: 2.627, 95 % CI: 1.850 to 3.731), and pancreatitis (OR: 3.734, 95 % CI: 2.958 to 4.712). No significant associations were found between the development of ARDS in septic patients and the following risk factors: sex (OR: 1.106, 95%CI: 0.957-1.279), smoking status (OR: 1.214, 95%CI: 0.835-1.765), or steroid use (OR: 0.901, 95%CI: 0.617-1.314). APACHE-II and SOFA scores were predictive of ARDS development, emphasizing their utility in clinical assessments.
Pulmonary infection, septic shock, and pancreatitis significantly increase ARDS risk in sepsis patients. Our findings advocate for targeted management of these risk factors to mitigate ARDS development, emphasizing the importance of personalized care in sepsis management.
急性呼吸窘迫综合征（ARDS）是脓毒症的一种严重并发症，发病率和死亡率都很高。识别脓毒症患者中ARDS的危险因素对于早期干预和改善预后至关重要。
我们进行了一项全面的荟萃分析，回顾了研究各种危险因素与脓毒症患者ARDS发生之间关联的研究。检索了截至2024年1月的PubMed、EMBASE、Cochrane图书馆、Medline、CINAHL和Web of Science等数据库，无语言限制。符合条件的研究包括观察性队列研究和病例对照研究。使用随机效应模型计算合并比值比（OR）和标准化平均差（SMD）。通过I统计量评估异质性，并通过Luis Furuya-Kanamori（LFK）指数评估发表偏倚。
分析了15项涉及40000多名参与者的研究。ARDS的显著危险因素包括肺部感染（OR：2.696，95%CI：1.655至4.390）、感染性休克（OR：2.627，95%CI：1.850至3.731）和胰腺炎（OR：3.734，95%CI：2.958至4.712）。在脓毒症患者中，未发现ARDS的发生与以下危险因素之间存在显著关联：性别（OR：1.106，95%CI：0.957-1.279）、吸烟状况（OR：1.214，95%CI：0.835-1.765）或类固醇使用（OR：0.901，95%CI：0.617-1.314）。APACHE-II和SOFA评分可预测ARDS的发生，强调了它们在临床评估中的实用性。
肺部感染、感染性休克和胰腺炎显著增加脓毒症患者发生ARDS的风险。我们的研究结果主张针对这些危险因素进行有针对性的管理，以减轻ARDS的发生，强调了个性化护理在脓毒症管理中的重要性。
