Analysis of clinical characteristics and prognosis in 75 patients with acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6902.2026.02.006

Abstract

Abstract:

Objective

To analyze the clinical characteristics and prognosis of patients with acute respiratory distress syndrome (ARDS).

Methods

The clinical data of 75 patients with ARDS admitted to the Second Affiliated Hospital of Army Medical University from December 2020 to January 2024 were retrospectively collected. They were grouped according to prognosis. 41 cases survived as the control group and 34 cases died as the observation group. Compare the basic information, laboratory indicators, lung injury prediction score (LIPS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)of the two groups. Logistic regression was used to analyze the prognostic risk factors of ARDS, and the prognosis of ARDS was predicted by the receiver operating characteristic (ROC) curve.

Results

Among 75 patients with ARDS, severe pulmonary infection in 46 cases (61.33%), severe acute pancreatitis in 19 cases (25.33%), sepsis in 5 cases (6.67%), and severe trauma in 5 cases (6.67%). Forty-one cases (54.67%) survived and 34 cases (45.33%) died. The age of the observation group was (63.06±13.52) years old, and APACHE The Ⅱ score (14.82±5.83) points, LIPS score (6.28±1.72) points, and oxygenation index (145.76±72.24) were statistically different from those of the control group (54.20±13.59) years old, (7.22±3.24) points, (4.63±1.36)points, and (205.27±61.30) (P<,0.05). Logistic regression analysis showed that age (OR: 1.080, 95%CI: 1.011~1.153), LIPS score (OR: 2.245, 95%CI: 1.252~4.027), APACHE Ⅱ score (OR: 1.263, 95%CI: 1.067~1.496) and oxygenation index (OR: 0.988, 95%CI: 0.977~1.000) were risk factors for the prognosis of ARDS. the area under the ROC curve (AUC) showed that the AUC of the APACHE Ⅱ score combined with the oxygenation index was 0.888, the Youden index was 0.707, the sensitivity was 0.853, and the specificity was 0.854.

Conclusion

The APACHE Ⅱ score combined with the oxygenation index can predict the prognosis of ARDS patients, which is helpful for the early identification of high-risk patients and provides a basis for targeted intervention.

Key words: Acute respiratory distress syndrome, Lung injury prediction score, Acute physiology and chronic health score Ⅱ, Oxygenation index, Prognosis

Zhixin Gan, Yongjun Hu, Qian Yang, Mingdong Hu. Analysis of clinical characteristics and prognosis in 75 patients with acute respiratory distress syndrome[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(02): 221-226.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhfbjbzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6902.2026.02.006

https://zhfbjbzz.cma-cmc.com.cn/EN/Y2026/V19/I02/221

Figures/Tables 4

References 32

1	Xie R, Tan D, Liu B, et al. Acute respiratory distress syndrome (ARDS): from mechanistic insights to therapeutic strategies[J]. MedComm, 2025, 6: e70074.
2	Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome[J]. Lancet, 2021, 398: 622-637.
3	张鹏，史慢慢，马辉，等. 急性呼吸窘迫综合征患者机械通气动脉血二氧化碳分压变异率与预后风险相关性[J/CD]. 中华肺部疾病杂志(电子版), 2025, 18(2): 226-230.
4	Auriemma CL, Zhuo H, Delucchi K, et al. Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis[J]. Intens Care Med, 2020, 46: 1222-1231.
5	Tetaj N, Piselli P, Zito S, et al. Timing and outcomes of noninvasive ventilation in 307 ARDS COVID-19 patients: an observational study in an italian third level COVID-19 hospital[J]. Medicina (Kaunas), 2022, 58: DOI: 10.3390/medicina58081104.
6	赵才林，向青，钱航，等. 基于生物信息学解析急性肺损伤/急性呼吸窘迫综合征铁死亡枢纽基因及其与免疫分型的关系[J/CD]. 中华肺部疾病杂志(电子版), 2025, 18(4): 503-509.
7	Moss M, Huang DT, Brower RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome[J]. New Engl J Med, 2019, 380: 1997-2008.
8	Hauschildt KE, Seigworth C, Kamphuis LA, et al. Patients′adaptations after acute respiratory distress syndrome: a qualitative study[J]. Am J Crit Care, 2021, 30: 221-229.
9	Herridge MS, Moss M, Hough CL, et al. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers[J]. Intensive Care Med, 2016, 42: 725-738.
10	Mikkelsen ME, Christie JD, Lanken PN, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury[J]. Am J Respir Crit Care Med, 2012, 185: 1307-1315.
11	Hopkins RO, Weaver LK, Collingridge D, et al. Two-year cognitive，emotional, and quality-of-life outcomes in acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2005, 171: 340-347.
12	Kor DJ, Lingineni RK, Gajic O, et al. Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study[J]. Anesthesiology, 2014, 120: 1168-1181.
13	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition[J]. JAMA, 2012, 307: 2526-2533.
14	Banavasi H, Nguyen P, Osman H, et al. Management of ARDS-what works and what does not[J]. Am J Med Sci, 2021, 362: 13-23.
15	Ge R, Wang F, Peng Z. Advances in biomarkers for diagnosis and treatment of ARDS[J]. Diagnostics (Basel), 2023, 13: 3296.
16	Aboab J, Louis B, Jonson B, et al. Relation between PaO₂/FiO₂ ratio and FiO₂: a mathematical description[J]. Intens Care Med, 2006, 32: 1494-1497.
17	Fremont RD, Koyama T, Calfee CS, et al. Acute lung injury in patients with traumatic injuries: Utility of a panel of biomarkers for diagnosis and pathogenesis[J]. J Trauma, 2010, 68: 1121-1127.
18	Ware LB, Koyama T, Zhao Z, et al. Biomarkers of lung epithelial injury and inflammation distinguish severe sepsis patients with acute respiratory distress syndrome[J]. Crit Care, 2013, 17: R253.
19	Ware LB, Zhao Z, Koyama T, et al. Derivation and validation of a two-biomarker panel for diagnosis of ARDS in patients with severe traumatic injuries[J]. Trauma Surg Acute Care Open, 2017, 2: e121.
20	Cardoso LG, Chiavone PA. The APACHE Ⅱ measured on patients′ discharge from the Intensive Care Unit in the prediction of mortality[J]. Rev Lat Am Enfermagem, 2013, 21: 811-819.
21	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: 604-609.
22	Gajic O, Dabbagh O, Park PK, 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: 462-470.
23	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.
24	Kim BK, Kim S, Kim CY, et al. Predictive role of lung injury prediction score in the development of acute respiratory distress syndrome in Korea[J]. Yonsei Med J, 2021, 62: 417-423.
25	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: 2182-2191.
26	Tekin A, Qamar S, Sharma M, et al. Development and validation of an acute respiratory distress syndrome prediction model in coronavirus disease 2019: Updated lung injury prediction score[J]. Mayo Clin Proc, 2023, 98: 736-747.
27	Cirik MO, Yenibertiz D. What are the prognostic factors affecting 30-day mortality in geriatric patients with respiratory failure in the Intensive Care Unit？[J]. Pak J Med Sci, 2021, 37: 15-20.
28	Lu W, Zhang J, Qiu Y, et al. Correlations between APACHE Ⅱ score and pressure parameters of mechanical ventilation in patients with ARDS and their value in prognostic evaluation[J]. Pak J Med Sci, 2023, 39: 1584-1588.
29	Singh G, Gladdy G, Chandy TT, et al. Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit[J]. Indian J Crit Care Med, 2014, 18: 659-665.
30	Behnoush AH, Khalaji A, Ghasemi H, et al. Endocan as a biomarker for acute respiratory distress syndrome: A systematic review and meta-analysis[J]. Health Sci Rep, 2024, 7: e70044.
31	van der Zee P, Rietdijk W, Somhorst P, et al. A systematic review of biomarkers multivariately associated with acute respiratory distress syndrome development and mortality[J]. Critical care (London, England), 2020, 24: 243.
32	Villar J, Herran-Monge R, Gonzalez-Higueras E, et al. Clinical and biological markers for predicting ARDS and outcome in septic patients[J]. Sci Rep, 2021, 11: 22702.

临床特征	观察组(n＝34)	对照组(n＝41)	t/Z/χ²值	P值
年龄(岁)	63.06±13.52	54.20±13.59	2.818	0.006
住院时间(d)	13.77±11.46	24.66±23.52	2.614	0.011
BMI(kg/m²)	24.21±3.64	24.76±4.16	0.480	0.633
体表面积(m²)	1.6±0.19	1.71±0.21	1.981	0.053
LIPS(分)	6.28±1.72	4.63±1.36	4.620	0.000
APACHEⅡ(分)	14.82±5.83	7.22±3.24	6.786	0.000
氧合指数(mmHg)	145.76±72.24	205.27±61.3	3.86	0.000
机械通气时间(d)	11.15±8.76	7.83±8.80	1.629	0.108
WBC(10⁹/L)	12.13±6.92	10.87±6.12	0.836	0.406
总蛋白(g/L)	57.95±10.2	59.9±12.32	0.735	0.465
白蛋白(g/L)	31.57±5.51	32.17±4.9	0.504	0.616
CRP(mg/L)	120.47±75.56	128.18±102.53	0.364	0.717
PCT(ng/ml)	11.65±26.54	6.04±13.63	1.115	0.270
总胆红素(μmol/L)	19.85±24.83	27.17±37.27	0.979	0.331
直接胆红素(μmol/L)	7.42±9.33	12.20±23.36	1.121	0.266
CK(U/L)	121.42±233.58	224.02±258.53	1.641	0.106
CKMB(U/L)	19.38±18.44	18.37±12.76	0.258	0.797
LDH(U/L)	527.78±302.89	688.59±863.06	0.938	0.352
肌酐(μmol/L)	101.09±76.79	101.76±112.18	0.029	0.977
ESR(mm 1 h)	48.51±32.69	46.98±33.85	0.174	0.862
尿素(mmol/L)	10.37±7.68	9.4±8.61	0.481	0.632
尿酸(μmol/L)	277.52±126.52	264.08±158.72	0.398	0.692
pH	7.40±0.75	7.40±0.90	0.146	0.885
GLU(mmol/L)	9.53±4.21	10.45±5.21	0.824	0.412
LAC(mmol/L)	1.84±1.50	1.73±1.01	0.382	0.703
BNP(pg/ml)	390.70±705.11	168.64±335.83	1.646	0.107
cTnI(ng/ml)	0.13±0.38	0.06±0.08	0.969	0.336
PT(s)	13.53±3.67	14.12±8.07	0.395	0.694
APTT(s)	34.4±10.57	30.68±5.05	1.886	0.066
TT(s)	16.15±3.84	14.58±3.07	1.970	0.053
D-D(mg/L)	4.88±6.28	3.14±5.12	1.319	0.191

临床特征	观察组(n＝34)	对照组(n＝41)	t/Z/χ²值	P值
年龄(岁)	63.06±13.52	54.20±13.59	2.818	0.006
住院时间(d)	13.77±11.46	24.66±23.52	2.614	0.011
BMI(kg/m²)	24.21±3.64	24.76±4.16	0.480	0.633
体表面积(m²)	1.6±0.19	1.71±0.21	1.981	0.053
LIPS(分)	6.28±1.72	4.63±1.36	4.620	0.000
APACHEⅡ(分)	14.82±5.83	7.22±3.24	6.786	0.000
氧合指数(mmHg)	145.76±72.24	205.27±61.3	3.86	0.000
机械通气时间(d)	11.15±8.76	7.83±8.80	1.629	0.108
WBC(10⁹/L)	12.13±6.92	10.87±6.12	0.836	0.406
总蛋白(g/L)	57.95±10.2	59.9±12.32	0.735	0.465
白蛋白(g/L)	31.57±5.51	32.17±4.9	0.504	0.616
CRP(mg/L)	120.47±75.56	128.18±102.53	0.364	0.717
PCT(ng/ml)	11.65±26.54	6.04±13.63	1.115	0.270
总胆红素(μmol/L)	19.85±24.83	27.17±37.27	0.979	0.331
直接胆红素(μmol/L)	7.42±9.33	12.20±23.36	1.121	0.266
CK(U/L)	121.42±233.58	224.02±258.53	1.641	0.106
CKMB(U/L)	19.38±18.44	18.37±12.76	0.258	0.797
LDH(U/L)	527.78±302.89	688.59±863.06	0.938	0.352
肌酐(μmol/L)	101.09±76.79	101.76±112.18	0.029	0.977
ESR(mm 1 h)	48.51±32.69	46.98±33.85	0.174	0.862
尿素(mmol/L)	10.37±7.68	9.4±8.61	0.481	0.632
尿酸(μmol/L)	277.52±126.52	264.08±158.72	0.398	0.692
pH	7.40±0.75	7.40±0.90	0.146	0.885
GLU(mmol/L)	9.53±4.21	10.45±5.21	0.824	0.412
LAC(mmol/L)	1.84±1.50	1.73±1.01	0.382	0.703
BNP(pg/ml)	390.70±705.11	168.64±335.83	1.646	0.107
cTnI(ng/ml)	0.13±0.38	0.06±0.08	0.969	0.336
PT(s)	13.53±3.67	14.12±8.07	0.395	0.694
APTT(s)	34.4±10.57	30.68±5.05	1.886	0.066
TT(s)	16.15±3.84	14.58±3.07	1.970	0.053
D-D(mg/L)	4.88±6.28	3.14±5.12	1.319	0.191

危险因素	单因素Logistics回归		多因素Logistics回归
危险因素	OR(95%CI)	P值	OR(95%CI)	P值
年龄	1.049(1.012~1.088)	0.009	1.080(1.011~1.153)	0.005
LIPS	1.997(1.381~2.889)	0.000	2.245(1.252~4.027)	0.002
APACHE Ⅱ	1.445(1.219~1.713)	0.000	1.263(1.067~1.496)	0.003
氧合指数	0.987(0.980~0.995)	0.001	0.988(0.977~1.000)	0.031

危险因素	单因素Logistics回归		多因素Logistics回归
危险因素	OR(95%CI)	P值	OR(95%CI)	P值
年龄	1.049(1.012~1.088)	0.009	1.080(1.011~1.153)	0.005
LIPS	1.997(1.381~2.889)	0.000	2.245(1.252~4.027)	0.002
APACHE Ⅱ	1.445(1.219~1.713)	0.000	1.263(1.067~1.496)	0.003
氧合指数	0.987(0.980~0.995)	0.001	0.988(0.977~1.000)	0.031

变　量	AUC	标准误	P值	95%CI	截断值	约登指数	敏感性	特异性
年龄	0.682	0.062	0.007	0.560~0.804	55.00	0.350	0.765	0.585
LIPS	0.771	0.055	0.000	0.663~0.879	4.25	0.448	0.912	0.537
APACHE Ⅱ	0.878	0.040	0.000	0.800~0.957	10.5	0.638	0.735	0.902
氧合指数	0.747	0.060	0.000	0.630~0.864	166.5	0.428	0.780	0.647
APACHE Ⅱ＋LIPS	0.897	0.037	0.000	0.825~0.970	0.279	0.687	0.882	0.805
APACHE Ⅱ＋氧合指数	0.888	0.040	0.000	0.810~0.966	0.342	0.707	0.853	0.854
APACHE Ⅱ＋LIPS＋氧合指数	0.900	0.037	0.000	0.828~0.973	0.255	0.697	0.941	0.756

Please choose a citation manager

Content to export