Bardají-Carrillo Miguel, Martín-Fernández Marta, López-Herrero Rocío, Priede-Vimbela Juan M, Arroyo-Hernantes Irene, Cobo-Zubia Rosa, Prieto-Utrera Rosa, Gómez-Sánchez Esther, Villar Jesús, Tamayo Eduardo
BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain.
Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain.
Front Med (Lausanne). 2025 Apr 17;12:1554752. doi: 10.3389/fmed.2025.1554752. eCollection 2025.
Despite the high mortality and economic burden associated with the acute respiratory distress syndrome (ARDS), the role of chest radiograph (CXR) in ARDS diagnosis and prognosis remains uncertain. The purpose of this study is to elucidate clinical characteristics that distinguish ARDS patients from those without ARDS, especially in patients where CXRs are indicative of ARDS.
Secondary analysis of a prospective observational study with 454 postoperative septic patients under mechanical ventilation (MV). Patients were stratified in two groups depending on whether they met the Berlin criteria for ARDS. Primary outcome was identification of clinical characteristics differentiating patients with ARDS confirmed by CXR from non-ARDS patients. Secondary outcome was 60-day in-hospital mortality of postoperative sepsis-induced ARDS.
One hundred thirty-nine patients (30.6%) had CXRs compatible with ARDS, although ARDS was confirmed in only 45 patients (9.9%). Emergency surgery (OR 6.6), abdominal source of infection (OR 6.0), pneumonia (OR 8.2), and higher lactate (OR 3.9) were clinical features associated with ARDS development confirmed by CXR. ARDS was an independent risk factor for 60-day mortality (OR 1.8).
Although CXR criteria for ARDS diagnosis could be replaced in future definitions, its importance for ARDS diagnosis should not be underestimated.
尽管急性呼吸窘迫综合征（ARDS）具有高死亡率和经济负担，但胸部X线片（CXR）在ARDS诊断和预后中的作用仍不确定。本研究的目的是阐明区分ARDS患者与非ARDS患者的临床特征，特别是在CXR提示ARDS的患者中。
对454例接受机械通气（MV）的术后脓毒症患者进行的前瞻性观察研究的二次分析。根据患者是否符合ARDS的柏林标准将其分为两组。主要结局是确定通过CXR确诊的ARDS患者与非ARDS患者之间的临床特征差异。次要结局是术后脓毒症诱发的ARDS患者60天的院内死亡率。
139例患者（30.6%）的CXR与ARDS相符，尽管仅45例患者（9.9%）确诊为ARDS。急诊手术（比值比6.6）、腹部感染源（比值比6.0）、肺炎（比值比8.2）和较高的乳酸水平（比值比3.9）是通过CXR确诊的与ARDS发生相关的临床特征。ARDS是60天死亡率的独立危险因素（比值比1.8）。
尽管ARDS诊断的CXR标准在未来定义中可能会被取代，但其对ARDS诊断的重要性不应被低估。
