Monchi M, Bellenfant F, Cariou A, Joly L M, Thebert D, Laurent I, Dhainaut J F, Brunet F
The Medical Intensive Care Unit of Cochin-Port-Royal University Hospital, Paris, France.
Am J Respir Crit Care Med. 1998 Oct;158(4):1076-81. doi: 10.1164/ajrccm.158.4.9802009.
To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/PaO2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.92, respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.
为确定新型治疗方法的潜在影响，我们在一家学术性三级护理医院的24张床位的医学重症监护病房中，研究了急性呼吸窘迫综合征（ARDS）发病时生存的早期预测因素。在48个月的时间里，共收治了3511例成年患者，其中259例机械通气患者符合美国-欧洲共识会议定义的ARDS标准，即双侧肺部浸润且PaO2/FIO2低于200且无左心房高压。这些患者被随机纳入一个发展样本（177例患者）和一个验证样本（82例患者）。收集了人口统计学变量、血流动力学和呼吸参数、基础疾病以及几个严重程度评分（SAPS, SAPS-II, OSF）和肺损伤评分（LIS）。对幸存者和非幸存者之间的这些变量进行比较，并将其纳入逐步逻辑回归模型以评估其独立的预后作用。总体死亡率为65%。SAPS-II、基础疾病的严重程度、氧合指数（平均气道压×FIO2×100/PaO2）、ARDS发生前的机械通气时间、肺损伤机制、肝硬化以及右心室功能障碍的发生与死亡风险升高独立相关。模型校准在发展样本和验证样本中都非常好（分别为p = 0.84和p = 0.72），模型判别也是如此（ROC曲线下面积分别为0.95和0.92）。因此，在调整一般严重程度评分后，ARDS的预后似乎与触发风险因素、呼吸系统疾病的严重程度以及右心室功能障碍有关。
