Ensarioğlu Kerem, Doğancı Melek, Cırık Mustafa Özgür, Ensarioğlu Mesher, Tüksal Erbil, Babayiğit Münire, Hazer Seray
Department of Pulmonary Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara 06290, Turkey.
Department of Anesthesiology and Reanimation, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara 06290, Turkey.
Diagnostics (Basel). 2025 Jul 15;15(14):1784. doi: 10.3390/diagnostics15141784.
Acute hypoxemic respiratory failure is a significant condition commonly seen in intensive care units (ICUs), yet specific prognostic markers related to it for mortality remain largely unstudied. This study aimed to identify parameters that influence mortality in ICU patients diagnosed with type 1 respiratory failure. A retrospective cohort study was conducted at a tertiary care hospital, including patients admitted to the ICU between March 2016 and March 2020. The study included patients with type 1 respiratory failure, while exclusion criteria were prior long-term respiratory support, type 2 respiratory failure, and early mortality (<24 h). Data on demographics, comorbidities, support requirements, laboratory values, and ICU scoring systems (APACHE II, SOFA, SAPS II, NUTRIC) were collected. Binomial regression analysis was used to determine independent predictors of 30-day mortality. Out of 657 patients screened, 253 met the inclusion criteria (mean age 70.6 ± 15.6 years; 65.6% male). Non-survivors ( = 131) had significantly higher CCI scores; greater vasopressor requirements; and elevated SAPS II, APACHE, SOFA, and NUTRIC scores. Laboratory findings indicated higher inflammatory markers and lower nutritional markers (albumin and prealbumin, respectively) among non-survivors. In the regression model, SAPS II (OR: 13.38, = 0.003), the need for inotropic support (OR: 1.11, = 0.048), NUTRIC score (OR: 2.75, = 0.014), and serum albumin (inverse; OR: 1.52, = 0.001) were independently associated with mortality. The model had an AUC of 0.926 and classified 83.2% of cases correctly. When combined, SAPS II and mNUTRIC had more AUC compared to either standalone scoring. SAPS II, vasopressor requirements, mNUTRIC score, and low serum albumin are independent predictors of 30-day mortality in patients with acute hypoxemic respiratory failure. These findings support the integration of nutritional assessment, a combination of available scoring systems and comprehensive scoring into routine ICU evaluations for this patient group.
急性低氧性呼吸衰竭是重症监护病房（ICU）中常见的一种严重病症，但与之相关的死亡率特异性预后标志物在很大程度上仍未得到研究。本研究旨在确定影响诊断为1型呼吸衰竭的ICU患者死亡率的参数。在一家三级护理医院进行了一项回顾性队列研究，纳入了2016年3月至2020年3月期间入住ICU的患者。该研究纳入了1型呼吸衰竭患者，排除标准为既往长期呼吸支持、2型呼吸衰竭和早期死亡（<24小时）。收集了人口统计学、合并症、支持需求、实验室检查值和ICU评分系统（急性生理与慢性健康状况评分系统II [APACHE II]、序贯器官衰竭评估 [SOFA]、简化急性生理学评分系统II [SAPS II]、营养风险与感染并发症评分 [NUTRIC]）的数据。采用二项式回归分析确定30天死亡率的独立预测因素。在657例筛查患者中，253例符合纳入标准（平均年龄70.6±15.6岁；65.6%为男性）。非存活者（n = 131）的Charlson合并症指数（CCI）评分显著更高；血管活性药物需求量更大；SAPS II、APACHE、SOFA和NUTRIC评分升高。实验室检查结果显示，非存活者的炎症标志物更高，营养标志物（分别为白蛋白和前白蛋白）更低。在回归模型中，SAPS II（比值比：13.38，P = 0.003）、使用血管活性药物支持的需求（比值比：1.11，P = 0.048）、NUTRIC评分（比值比：2.75，P = 0.014）和血清白蛋白（反向；比值比：1.52，P = 0.001）与死亡率独立相关。该模型的曲线下面积（AUC）为0.926，正确分类了83.2%的病例。与单独使用评分系统相比，SAPS II和改良NUTRIC评分联合使用时的AUC更高。SAPS II、血管活性药物需求量、改良NUTRIC评分和低血清白蛋白是急性低氧性呼吸衰竭患者30天死亡率的独立预测因素。这些发现支持将营养评估、现有评分系统的组合以及综合评分纳入该患者群体的ICU常规评估中。
