脓毒症相关急性呼吸窘迫综合征的危险因素及预后分析

Risk factors and prognosis of sepsis-associated acute respiratory distress syndrome

目的探讨脓毒症相关急性呼吸窘迫综合征(ARDS)的危险因素及影响预后的相关因素,为临床早期识别高危ARDS患者及改善患者临床预后提供依据。方法对大连医科大学附属第一医院重症加强治疗病房(intensive care unit,ICU)2019年10月至2021年1月收治的174例脓毒症患者资料进行回顾性分析,根据患者是否并发ARDS分成ARDS组和非ARDS组;根据临床结局将ARDS组分为两个亚组:生存组和死亡组,分析脓毒症相关ARDS的危险因素及影响预后的相关因素。结果脓毒症相关ARDS的发生率为33.91%(59/174)。ARDS组和非ARDS组之间临床特征比较:入院时是否存在休克、血清前白蛋白(PA)、白蛋白(ALB)、血清降钙素原(PCT),以及是否机械通气、是否行连续性肾脏替代治疗(CRRT)、是否侵入性置管、是否应用血管活性药物、急性生理学与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)、住ICU时间、机械通气时间、28 d病死率、ICU内病死率差异均有统计学意义(P<0.05);二元Logistic回归分析显示,血清PA(OR=0.988,95%CI 0.981~0.995,P=0.000)、APACHEⅡ评分(OR=1.121,95%CI 1.007~1.246,P=0.046)是脓毒症相关ARDS的危险因素。ARDS生存组和死亡组间血清PA、ALB、血糖(Glu)、血乳酸(Lac)差异有统计学意义(P<0.01);年龄、心率(HR)、凝血酶原时间(PT)、氧合指数(PaO_(2)/FiO_(2))、是否侵入性置管、SOFA评分和APACHEⅡ评分差异有统计学意义(P<0.05);进一步二元Logistic回归分析结果显示,血清PA(OR=0.960,95%CI 0.929~0.991,P=0.000)、ALB(OR=0.800,95%CI 0.620~1.033,P=0.029)及血Lac(OR=1.522,95%CI 0.577~4.016,P=0.002)、SOFA评分(OR=1.315,95%CI 0.860~2.010,P=0.022)和APACHEⅡ评分(OR=1.077,95%CI 0.871~1.331,P=0.027)是ARDS患者死亡的危险因素。结论脓毒症相关ARDS具有较高的发病率及病死率,血清PA和APACHEⅡ评分是脓毒症并发ARDS的危险因素,血清PA、ALB、血Lac和SOFA评分、APACHEⅡ评分是影响脓毒症相关ARDS临床预后的危险因素。

Objective To explore the risk factors and prognostic factors in the patients with sepsis-associated acute respiratory distress syndrome(ARDS)in order to improve the prognosis of high-risk septic patients.Methods A total of 174 consecutive patients with a confirmed diagnosis of sepsis from October 2019 to January 2021 were hospitalized to the intensive care unit(ICU)of the First Affiliated Hospital of Dalian Medical University,the data of the septic patients were analyzed retrospectively.The patients were divided into ARDS group and non-ARDS group.According to the clinical outcome,the patients in ARDS group were divided into two subgroups:survival group and death group.We analyzed the risk factors and prognostic factors of patients with sepsis-associated ARDS.Results The incidence of sepsis-associated ARDS was 33.91%(59/174),there were statistically significant differences in shock,prealbumin(PA),albumin(ALB),procalcitonin(PCT)mechanical ventilation,continuous renal replacement therapy(CRRT),invasive catheterization,application of vasoactive agents,acute physiology and chronic health evaluation(APACHE)Ⅱscore,sequential organ failure assessment(SOFA)score,length of stay ICU,duration of mechanical ventilation,28-day mortality and ICU mortality between ARDS and non-ARDS group(P<0.01).Logistic regression analysis showed that PA(OR=0.988,95%CI=0.981-0.995,P=0.000)and APACHEⅡscore(OR=1.121,95%CI 1.007-1.246,P=0.036)were risk factors for sepsis-associated ARDS.There were significantly different in PA,ALB,blood glucose(Glu),and blood lactate(Lac)(P<0.01),and there were statistically different in age,heart rate(HR),prothrombin time(PT),PaO_(2)/FiO_(2),invasive catheterization,SOFA score and APACHEⅡscore(P<0.05).The Logistic regression analysis further showed that PA(OR=0.960,95%CI 0.929-0.991,P=0.000),ALB(OR=0.800,95%CI 0.620-1.033,P=0.029),Lac(OR=1.522,95%CI 0.577-4.016,P=0.002),SOFA score(OR=1.315,95%CI 0.860-2.010,P=0.022),APACHEⅡscore(OR=1.077,95%CI 0.871-1.331,P=0.027)were risk factors for the death of ARDS patients.Conclusions Sepsis-associated ARDS had high morbidity and mortality.The PA and APACHEⅡscore were the risk factors for ARDS in septic patients.The PA,ALB and Lac,SOFA score and APACHEⅡscore were the related factors affecting sepsis-associated ARDS patients′prognosis.