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.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2021.02.006

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2021/V14/I02/164

Figures/Tables 4

References 16

1	Ary SN, Carmen SVB, Fabienne DS, et al. Epidemiological characteristics，practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study[J]. Lancet Respir Med, 2016, 4(11): 882-893.
2	Andrés E, Fernando FV, Alfonso M, et al. Evolution of mortality over time in patients receiving mechanical ventilation[J]. Am J Respir Crit Care Med, 2013, 188(2): 220-230.
3	Elisabeth DR, Willy K, Theogene T, et al. Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition[J]. Am J Respir Crit Care Med, 2016, 193(1): 52-59.
4	Giacomo B, John GL, Tài P, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries[J]. JAMA, 2016, 315(8): 788-800.
5	Michael AM, Rachel LZ, Guy AZ, et al. Acute respiratory distress syndrome[J]. Nat Rev Dis Primers, 2019, 5(1): 18.
6	Frat J, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure[J]. N Engl J Med, 2015, 372(23): 2185-2196.
7	Andrew JB, Fabiana M, John GL, et al. Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database[J]. Crit Care, 2018, 22(1): 268.
8	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307(23): 2526-2533.
9	Pablo CF, José AL, Aída BB, et al. Acute respiratory distress syndrome and diffuse alveolar damage. New insights on a complex relationship[J]. Ann Am Thorac Soc, 2017, 14(6): 844-850.
10	Kenneth TH, Mary BB. Pulmonary Manifestations of acute lung injury：More than just diffuse alveolar damage[J]. Arch Pathol Lab Med, 2017, 141(7): 916-922.
11	Trillo-Alvarez C, Cartin-Ceba R, Kor DJ, et al. Acute lung injury prediction score: derivation and validation in a population-based sample[J]. Eur Respir J, 2011, 37(3): 604-609.
12	Ognjen G, Ousama D, Pauline KP, et al. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study[J]. Am J Respir Crit Care Med, 2011, 183(4): 462-470.
13	Soto GJ, Kor DJ, Park PK, et al. Lung injury prediction score in hospitalized patients at risk of acute respiratory distress syndrome[J]. Crit Care Med, 2016, 44(12): 2182-2191.
14	Ahmed ME, Hamed G, Fawzy S, et al. Lung injury prediction scores：Clinical validation and C-reactive protein involvement in high risk patients[J]. Med Intensiva, 2020, 44(5): 267-274.
15	Xu Z, Wu GM, Li Q, et al. Predictive value of combined LIPS and ANG-2 level in critically Ⅲ patients with ARDS risk factors[J]. Mediators Inflamm, 2018, 2018: 1739615.
16	Graeme R, Deborah C, Peter S, et al. Clinician predictions of intensive care unit mortality[J]. Crit Care Med, 2004, 32(5): 1149-1154.

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	-	-

[1]	Zhenhe Li, Changqing Wei, Guodong Zhen, Zhenfu Li. Changes of serum S1P and Wnt5a in patients with sepsis complicating acute respiratory distress syndrome and their clinical significance [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(04): 293-300.
[2]	Lie Zhang, Yihe Yan, Jieyu Du. Predictive efficacy of secretory leukocyte protease inhibitor in severe pneumonia patients with non-invasive ventilation [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(04): 301-306.
[3]	Jinli Zhang, Maomao Xi, Zhigang Chu, Xiagang Luan, Nuo Chen, Deyun Wang, Weiguo Xie. Analysis of risk factors of early acute kidney injury in patients with massive burn injuries [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(04): 282-287.
[4]	Shijie Li, Chuan′an Shen. Research status of ventilator-associated pneumonia in burn patients with inhalation injury [J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(04): 351-355.
[5]	Wenbin Luo, Wei Han. Analysis of risk factors related to moderate to severe myelosuppression in patients with pancreatic cancer after first chemotherapy and construction of prediction model [J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(05): 357-362.
[6]	Guoyu Li, Yun Cong, Maimaitiaili Zulihumaer·, Tieying He. Risk factors and prediction model built for portal vein system thrombosis in patients with acute pancreatitis [J]. Chinese Archives of General Surgery(Electronic Edition), 2024, 18(04): 266-270.
[7]	Bin He, Jinfeng Ma. Risk factors for splenic hilar lymph node metastasis in gastric cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 694-699.
[8]	Junlong Huang, Bolong Liu, Ruixiang Luo, Xiaoyang Li, Wenshuang Li, Zheng Liu, Jialiang Chen, Xiangfu Zhou. A combined analysis of clinical data and pelvic floor ultrasound data for exploring the risk factors of stress urinary incontinence [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(04): 323-330.
[9]	Jie Jiang, Cheng Shen, Yongsheng Pan, Xinfeng Chen, Zhenmin Liu, Hua Zhu, Bing Zheng. Analysis of risk factors and dual-energy CT features of uric acid calculi [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(04): 361-365.
[10]	Jinhong Zhou, Jianjie Wang, Xiaojun Xie. Analysis of incidence and risk factors of postoperative urinary retention after TAPP [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(04): 390-395.
[11]	Zhao Chen, Keli Zhong, Zhipeng Jiang, Yuxiang Fu, Baohang Fan, Wenfei Wu. Analysis of incidence and risk factors of inguinal hernia after prostate cancer surgery [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(04): 396-401.
[12]	Xu Ji, Feng Zhu, Yechen Feng. Risk factors of biliary complications after organ-preserving pancreatectomy [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(04): 509-514.
[13]	Huiying Chen, Minshan Qiu, Hanquan Shao. Construction and application effect of risk factor model for intestinal mucosal barrier function damage induced by sepsis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 448-452.
[14]	Wei Duan, Fei Liu, Guangyuan Xu, Yuhao Cheng, Xing Chen. Effect of different dosimetric parameters of intensity modulated radiotherapy plans for esophageal cancer on the occurrence and severity of radiation pneumonia [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 320-324.
[15]	Xiangqing Qin, Chen Zhu, Haiyin Zhang. Construction of a normogram model for predicting the risk of esophageal and gastric varices bleeding in cirrhosis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 330-335.

Please choose a citation manager

Content to export