Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Lhasa People's Hospital, Lhasa, Tibet, People's Republic of China.
Sci Rep. 2024 Oct 3;14(1):22999. doi: 10.1038/s41598-024-73922-7.
Acute respiratory distress syndrome (ARDS) is a heterogeneous disease with extremely high mortality. We hypothesized that the serum β2-microglobulin (β2MG) level would be elevated and be an independent risk factor for 28-day mortality in patients with ARDS caused by bacterial infection. We retrospectively enrolled 257 patients with ARDS caused by bacterial infection from January 1, 2015 to February 28, 2021. Patients were followed for up to 28 days and were divided into a survival group and non-survival group according to their clinical outcomes. The serum β2MG levels and other clinical data were collected. The relationship between β2MG levels and 28-day mortality was explored by performing a Cox regression analysis adjusted for age, updated Charlson comorbidity index, disorders of consciousness, septic shock, albumin level, cardiac troponin I level, procalcitonin level, lactic acid level, prothrombin time, partial pressure of arterial oxygen/fraction of inspired oxygen ratio, estimated glomerular filtration rate and Sequential Organ Failure Assessment. In this cohort, 96 patients died in 28 days, yielding a 28-day mortality of 37.4%. The median level of serum β2MG for all enrolled patients was 4.7 (interquartile range [IQR]: 2.9-8.5) mg/L. Higher β2MG levels were significantly associated with 28-day mortality when the β2MG level was analysed as a continuous variable (hazard ratio [HR]: 1.053; 95% confidence interval [CI] 1.004-1.104; P = 0.032) and when it was categorized into tertiles (HR: 3.241; 95% CI 1.180-8.905; P = 0.023). The β2MG level exhibited a high diagnostic accuracy for predicting 28-day mortality (area under the curve [AUC] = 0.732; 95% CI 0.673-0.785; sensitivity: 74.0%; specificity: 64.0%; P < 0.001). The level of serum β2MG is elevated and is an independent risk factor of 28-day mortality in patients with ARDS caused by bacterial infection.
急性呼吸窘迫综合征（ARDS）是一种异质性疾病，死亡率极高。我们假设血清β2-微球蛋白（β2MG）水平升高是细菌感染引起的 ARDS 患者 28 天死亡率的独立危险因素。我们回顾性纳入了 2015 年 1 月 1 日至 2021 年 2 月 28 日期间因细菌感染引起的 257 例 ARDS 患者。对患者进行了长达 28 天的随访，并根据临床结局将其分为存活组和非存活组。收集了血清β2MG 水平和其他临床数据。通过调整年龄、更新的 Charlson 合并症指数、意识障碍、感染性休克、白蛋白水平、心肌肌钙蛋白 I 水平、降钙素原水平、乳酸水平、凝血酶原时间、动脉血氧分压/吸入氧分数比、估计肾小球滤过率和序贯器官衰竭评估，采用 Cox 回归分析探讨β2MG 水平与 28 天死亡率的关系。在该队列中，96 例患者在 28 天内死亡，28 天死亡率为 37.4%。所有入组患者的血清β2MG 中位数为 4.7（四分位距[IQR]：2.9-8.5）mg/L。当β2MG 水平作为连续变量进行分析时（危险比[HR]：1.053；95%置信区间[CI] 1.004-1.104；P=0.032）和分为三分位数时（HR：3.241；95%CI 1.180-8.905；P=0.023），更高的β2MG 水平与 28 天死亡率显著相关。β2MG 水平对预测 28 天死亡率具有较高的诊断准确性（曲线下面积[AUC] = 0.732；95%CI 0.673-0.785；敏感性：74.0%；特异性：64.0%；P<0.001）。血清β2MG 水平升高是细菌感染引起的 ARDS 患者 28 天死亡率的独立危险因素。
