Study on the risk factors of ARDS in patients with pneumonia complicated with hypoxemia

doi:10.3877/cma.j.issn.1674-6902.2021.02.006

Abstract

Abstract:

Objective

To explore the early risk factors of ARDS in patients with pneumonia complicated with hypoxemia.

Methods

In a retrospective case-control study, 64 patients with pneumonia complicated with hypoxemia treated in Xin qiao Hospital of the third military Medical University from January 1, 2016 to December 30, 2019 were divided into ARDS case group 32 and control group 32 according to whether the patients developed into ARDS. The clinical data of sex, age, complications, surgery, vital signs, laboratory examination, acute physiology and chronic health score Ⅱ (APACHE Ⅱ), pneumonia severity score (PSI) and lung injury prediction score (LIPS) were collected from the two groups of patients with pneumonia complicated with hypoxemia. Univariate analysis and binary logistic regression were used to analyze the early risk factors of ARDS. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of each index.

Results

Univariate analysis showed: respiratory frequency (Z=-2.18, P=0.03), pulse (Z=-2.70, P=0.01), AST (Z=-2.14, P=0.03), ALT (Z=-1.96, P<0.05), PaO₂/FiO₂ (t=-3.43, P=0.00), LIPS(Z=-3.87, P=0.00), the difference between the two groups was statistically significant(P<0.05); in the multivariate logistic regression analysis, LIPS Score (OR=2.24, 95%CI: 1.32-3.81), 100 mmHg<PaO₂/FiO₂≤200 mmHg(OR=6.55, 95%CI: 1.40-30.68), and PaO₂/FiO₂≤100 mmHg(OR=14.29, 95%CI: 1.05-194.41) were independent risk factors for the occurrence of ARDS; ROC curve analysis showed that both LIPS and PaO₂/FiO₂ could predict the occurrence of ARDS in patients with pneumonia and hypoxemia. The AUC of LIPS was 0.78 (P<0.01), and the threshold was 4 points, the sensitivity was 72.0%, the specificity was 72.0%, and the positive predictive value was 72.0%; The AUC of PaO₂/FiO₂ was 0.73 (P<0.01), the threshold was 182.90 mmHg, the sensitivity was 59.0%, the specificity was 81.0%, and the positive predictive value was 67.0%. When the both were jointly predicted, the AUC was 0.83 (P<0.01), the sensitivity was 72.0%, and the specificity was 81.0%.

Conclusion

LIPS and PaO₂/FiO₂ were independent risk factors for the progression of ARDS in patients with pneumonia complicated with hypoxemia. Patients with LIPS≥4 points and PaO₂/FiO₂≤182.90 mmHg had a significantly higher risk of ARDS. The combined prediction of ARDS was better than a single index.

Key words: Pneumonia, Hypoxemia, Acute respiratory distress syndrome, Risk factors

Shichen Liu, Meiju Wang, Gang Liu, Shuanglin Liu, Jing Xu, Qingjia Xu, Hong Yu, Qi Li. Study on the risk factors of ARDS in patients with pneumonia complicated with hypoxemia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(02): 164-168.

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Figures/Tables 4

References 16

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临床资料	ARDS组(n＝32)	非ARDS组(n＝32)	χ²/t/Z	P值
CRP[mg/L, M(Q_L，Q_U)]	146.00(77.20，200.00)	119.35(23.45，186.40)	-1.24	0.22
PCT[ng/ml, M(Q_L，Q_U)]	0.71(0.21，2.79)	0.71(0.20，1.19)	-0.69	0.49
TD3[个/nl, M(Q_L，Q_U)]	404.00(222.00，628.00)	440.00(315.00，624.00)	-1.02	0.31
TD4[个/nl, M(Q_L，Q_U)]	160.00(84.00，298.00)	198.00(127.00，337.00)	-0.88	0.38
TD8[个/nl, M(Q_L，Q_U)]	156.00(102.00，284.00)	202.00(140.00，320.00)	-1.32	0.19
CD4/CD8[M(Q_L，Q_U)]	1.00(0.80，1.10)	0.90(0.80，1.10)	-0.3	0.76
Ur[mmol/L, M(Q_L，Q_U)]	8.97(5.88，11.77)	7.49(5.07，11.91)	-0.39	0.70
SCr[μmol/L, M(Q_L，Q_U)]	75.25(65.03，101.20)	65.65(56.63，117.65)	-1.03	0.30
ALB(g/L，±s)	29.18±4.81	30.28±5.51	-0.85	0.40
AST[IU/L, M(Q_L，Q_U)]	27.55(19.39，53.78)	46.70(30.98，75.08)	-2.14	0.03
ALT[IU/L, M(Q_L，Q_U)]	19.95(11.80，41.70)	40.65(14.73，79.05)	-1.96	0.05
TBil[μmol/L, M(Q_L，Q_U)]	13.15(9.30，22.68)	13.60(8.50，21.18)	-0.21	0.84
PT[s, M(Q_L，Q_U)]	12.40(11.08，13.90)	12.50(11.63，13.88)	-0.51	0.61
HBAlC[%, M(Q_L，Q_U)]	6.00(5.50，7.20)	6.00(5.53，6.68)	-0.15	0.88
血糖[mmol/L, M(Q_L，Q_U)]	5.00(4.22，7.49)	5.86(4.74，8.94)	-1.63	0.10
pH值(±s)	7.43±0.06	7.44±0.06	-1.3	0.20
Lac[mmol/L, M(Q_L，Q_U)]	1.90(1.23，2.78)	1.60(1.20，2.18)	-1.43	0.15
Ca²⁺[mmol/L, M(Q_L，Q_U)]	1.12(1.03，1.16)	1.11(1.05，1.15)	-0.03	0.97
PaO₂/FiO₂(mmHg，±s)	151.82±44.01	189.10±43.04	-3.43	0.00
APACHE Ⅱ(分，±s)	13.34±4.82	12.41±4.63	0.79	0.43
LIPS[分，M(Q_L，Q_U)]	4.75(3.50，5.50)	3.50(2.50，4.50)	-3.87	0.00
PSI(分，±s)	113.69±31.9	112.59±28.69	0.14	0.89

临床资料	ARDS组(n＝32)	非ARDS组(n＝32)	χ²/t/Z	P值
CRP[mg/L, M(Q_L，Q_U)]	146.00(77.20，200.00)	119.35(23.45，186.40)	-1.24	0.22
PCT[ng/ml, M(Q_L，Q_U)]	0.71(0.21，2.79)	0.71(0.20，1.19)	-0.69	0.49
TD3[个/nl, M(Q_L，Q_U)]	404.00(222.00，628.00)	440.00(315.00，624.00)	-1.02	0.31
TD4[个/nl, M(Q_L，Q_U)]	160.00(84.00，298.00)	198.00(127.00，337.00)	-0.88	0.38
TD8[个/nl, M(Q_L，Q_U)]	156.00(102.00，284.00)	202.00(140.00，320.00)	-1.32	0.19
CD4/CD8[M(Q_L，Q_U)]	1.00(0.80，1.10)	0.90(0.80，1.10)	-0.3	0.76
Ur[mmol/L, M(Q_L，Q_U)]	8.97(5.88，11.77)	7.49(5.07，11.91)	-0.39	0.70
SCr[μmol/L, M(Q_L，Q_U)]	75.25(65.03，101.20)	65.65(56.63，117.65)	-1.03	0.30
ALB(g/L，±s)	29.18±4.81	30.28±5.51	-0.85	0.40
AST[IU/L, M(Q_L，Q_U)]	27.55(19.39，53.78)	46.70(30.98，75.08)	-2.14	0.03
ALT[IU/L, M(Q_L，Q_U)]	19.95(11.80，41.70)	40.65(14.73，79.05)	-1.96	0.05
TBil[μmol/L, M(Q_L，Q_U)]	13.15(9.30，22.68)	13.60(8.50，21.18)	-0.21	0.84
PT[s, M(Q_L，Q_U)]	12.40(11.08，13.90)	12.50(11.63，13.88)	-0.51	0.61
HBAlC[%, M(Q_L，Q_U)]	6.00(5.50，7.20)	6.00(5.53，6.68)	-0.15	0.88
血糖[mmol/L, M(Q_L，Q_U)]	5.00(4.22，7.49)	5.86(4.74，8.94)	-1.63	0.10
pH值(±s)	7.43±0.06	7.44±0.06	-1.3	0.20
Lac[mmol/L, M(Q_L，Q_U)]	1.90(1.23，2.78)	1.60(1.20，2.18)	-1.43	0.15
Ca²⁺[mmol/L, M(Q_L，Q_U)]	1.12(1.03，1.16)	1.11(1.05，1.15)	-0.03	0.97
PaO₂/FiO₂(mmHg，±s)	151.82±44.01	189.10±43.04	-3.43	0.00
APACHE Ⅱ(分，±s)	13.34±4.82	12.41±4.63	0.79	0.43
LIPS[分，M(Q_L，Q_U)]	4.75(3.50，5.50)	3.50(2.50，4.50)	-3.87	0.00
PSI(分，±s)	113.69±31.9	112.59±28.69	0.14	0.89

指　标	AUC	95%CI	阈值	敏感度	特异度	阳性预测值	阴性预测值
PaO₂/FiO₂	0.73	0.60～0.85	182.90	0.59	0.81	0.67	0.76
LIPS	0.78	0.66～0.89	4.00	0.72	0.72	0.72	0.72
两者联合	0.83	0.73～0.93	-	0.72	0.81	-	-

指　标	AUC	95%CI	阈值	敏感度	特异度	阳性预测值	阴性预测值
PaO₂/FiO₂	0.73	0.60～0.85	182.90	0.59	0.81	0.67	0.76
LIPS	0.78	0.66～0.89	4.00	0.72	0.72	0.72	0.72
两者联合	0.83	0.73～0.93	-	0.72	0.81	-	-

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