Li Nahui, Wang Hongfei, Zhu Lin
Department of Intensive Care Unit, Key Laboratory for Critical Care Medicine of The Ministry of Health, Emergency Medicine Research Institute, Tianjin First Central Hospital, Tianjin, China.
Med Sci Monit. 2025 Jun 5;31:e947681. doi: 10.12659/MSM.947681.
BACKGROUND Sepsis-associated acute respiratory distress syndrome (ARDS) has a high incidence and mortality, and the characteristic differences between positive and negative results for pathogenic microorganisms with sepsis-associated ARDS remain unclear. This study explored differences in the characteristics of patients with sepsis-associated ARDS with positive and negative results for pathogenic microorganisms. MATERIAL AND METHODS The study was a retrospective cohort study. We searched the population for sepsis-associated ARDS from the Medical Information Mart for Intensive Care IV (MIMIC IV) and electronic Intensive Care Unit (eICU) databases. The objective of this study was to compare the characteristics and prognosis of patients with sepsis with pathogenic microorganisms-associated ARDS using non-parametric tests, Wilcoxon, univariate, and multivariate COX regression analyses, receiver operating characteristic (ROC) curves, and other methods. RESULTS Compared with pathogenic microbial-negative sepsis-associated ARDS, patients with pathogenic microbial-positive sepsis-associated ARDS had worse oxygenation indices and prognosis, lower levels of PaO₂, PaO₂/FiO₂, SpO₂/FiO₂, and SpO₂/FiO₂*respiratory rate, and a higher mortality rate at 28 days and 90 days. Age, INR, lactate level, Acinetobacter baumannii infection, continuous renal replacement therapy treatment, and SOFA score were independent risk factors for mortality in patients with pathogenic microorganism-positive sepsis-associated ARDS. In particular, patients with sepsis-associated ARDS infected with A. baumannii had a worse prognosis. After fitting the above risk factors into the model, the prognostic evaluation ability of ARDS associated with positive pathogenic microorganisms was significantly improved. CONCLUSIONS Patients with pathogenic microorganism-positive sepsis-associated ARDS, especially those with A. baumannii infection, had a poor prognosis and should receive timely attention in clinical practice.
背景 脓毒症相关性急性呼吸窘迫综合征（ARDS）的发病率和死亡率较高，脓毒症相关性ARDS致病微生物检测结果呈阳性和阴性的特征差异尚不清楚。本研究探讨了脓毒症相关性ARDS致病微生物检测结果呈阳性和阴性的患者特征差异。材料与方法 本研究为回顾性队列研究。我们从重症监护医学信息数据库IV（MIMIC IV）和电子重症监护病房（eICU）数据库中筛选脓毒症相关性ARDS患者。本研究的目的是使用非参数检验、Wilcoxon检验、单因素和多因素COX回归分析、受试者工作特征（ROC）曲线等方法比较脓毒症合并致病微生物相关性ARDS患者的特征和预后。结果 与致病微生物检测结果为阴性的脓毒症相关性ARDS患者相比，致病微生物检测结果为阳性的脓毒症相关性ARDS患者的氧合指数和预后更差，PaO₂、PaO₂/FiO₂、SpO₂/FiO₂和SpO₂/FiO₂×呼吸频率水平更低，28天和9天的死亡率更高。年龄、国际标准化比值（INR）、乳酸水平、鲍曼不动杆菌感染、持续肾脏替代治疗以及序贯器官衰竭评估（SOFA）评分是致病微生物检测结果为阳性的脓毒症相关性ARDS患者死亡的独立危险因素。特别是，感染鲍曼不动杆菌的脓毒症相关性ARDS患者预后更差。将上述危险因素纳入模型后，致病微生物检测结果为阳性的ARDS的预后评估能力显著提高。结论 致病微生物检测结果为阳性的脓毒症相关性ARDS患者，尤其是感染鲍曼不动杆菌的患者，预后较差，在临床实践中应及时予以关注。
