Department of Medicine, Division of Pulmonary, and Critical Care Medicine, Downstate Health Sciences University, Brooklyn, NY, USA.
Department of Medicine, UPMC Health Systems, Pittsburgh, PA, USA.
Respir Res. 2024 Nov 8;25(1):400. doi: 10.1186/s12931-024-03027-2.
Acute respiratory distress syndrome (ARDS) is characterized by diffuse lung injury. The impact of pre-existing chronic obstructive pulmonary disease (COPD) or emphysema on ARDS pathogenesis is not well characterized.
Secondary analysis of ARDS patients enrolled in the Acute Lung Injury Registry and Biospecimen Repository at the University of Pittsburgh between June 2012 and September 2021. Patients were categorized into two mutually exclusive groups by the prevalence of COPD or emphysema at the time of ARDS diagnosis. The COPD/emphysema group comprised ARDS patients with radiological evidence of emphysema, chart diagnosis of COPD, or both. Demographics, lung mechanics, and clinical outcomes were obtained from the electronic medical record. Host-response biomarkers known to have validated associations with ARDS were previously measured in plasma and lower respiratory tract samples using a customized Luminex assay. Continuous and categorical variables were compared between groups with and without COPD/emphysema.
217 patients with ARDS were included in the study, 57 (27%) had COPD/emphysema. Patients with COPD/emphysema were older (median 62 [interquartile range 55-69] versus 53 [41-64] years, p < 0.01), more likely to be male (62% vs. 44%, p = 0.02) and had a higher prevalence of congestive heart failure (25% vs. 4%, p < 0.01) compared to patients without COPD/emphysema. Baseline demographics, laboratory parameters, and mechanical ventilatory characteristics were otherwise similar between the two groups. No difference in 90-day mortality was observed between groups; however, patients with COPD/emphysema had shorter duration of intensive care unit (ICU) stay (median 10 [7-18] versus 16 [9-28] days, p = 0.04) and shorter duration of mechanical ventilation (median 7 [4-16] vs. 12 [6-20] days, p = 0.01). Host response biomarkers in serum and lower respiratory tract samples did not significantly differ between groups.
ARDS patients with COPD or emphysema had similar respiratory mechanics, host response biomarker profiles, and mortality compared to those without COPD or emphysema but with a shorter median duration of mechanical ventilation and ICU length of stay. Future studies should address differences in clinical and biological responses by disease severity, and should investigate the impact of severity of COPD and emphysema on mechanical ventilation and targeted therapeutic strategies in ARDS.
Not applicable.
急性呼吸窘迫综合征（ARDS）的特征是弥漫性肺损伤。预先存在的慢性阻塞性肺疾病（COPD）或肺气肿对 ARDS 发病机制的影响尚未得到很好的描述。
对 2012 年 6 月至 2021 年 9 月期间在匹兹堡大学急性肺损伤登记处和生物标本库中登记的 ARDS 患者进行二次分析。根据 ARDS 诊断时 COPD 或肺气肿的存在情况，将患者分为两组，这两组是互斥的。COPD/肺气肿组包括有肺气肿放射学证据、图表诊断为 COPD 或两者兼有的 ARDS 患者。从电子病历中获取人口统计学、肺力学和临床结局数据。先前使用定制的 Luminex 测定法，在血浆和下呼吸道样本中测量了与 ARDS 具有验证关联的宿主反应生物标志物。
纳入研究的 217 名 ARDS 患者中，有 57 名（27%）患有 COPD/肺气肿。患有 COPD/肺气肿的患者年龄更大（中位数 62 [四分位距 55-69] 岁与 53 [41-64] 岁，p<0.01），更可能为男性（62%比 44%，p=0.02），充血性心力衰竭的发生率更高（25%比 4%，p<0.01）与无 COPD/肺气肿的患者相比。两组之间的基线人口统计学、实验室参数和机械通气特征否则相似。两组之间 90 天死亡率无差异；然而，患有 COPD/肺气肿的患者 ICU 住院时间更短（中位数 10 [7-18] 天与 16 [9-28] 天，p=0.04），机械通气时间更短（中位数 7 [4-16] 天与 12 [6-20] 天，p=0.01）。血清和下呼吸道样本中的宿主反应生物标志物在两组之间没有显著差异。
与无 COPD 或肺气肿但机械通气时间和 ICU 住院时间更短的 ARDS 患者相比，患有 COPD 或肺气肿的 ARDS 患者的呼吸力学、宿主反应生物标志物谱和死亡率相似。未来的研究应根据疾病严重程度来解决临床和生物学反应的差异，并应研究 COPD 和肺气肿严重程度对 ARDS 中机械通气和靶向治疗策略的影响。
不适用。
