RALE评分与LUS评分的相关性及其对ARDS患者预后的价值研究

Correlation between RALE score and LUS score and its value in the severity and prognosis of acute respiratory distress syndrome

目的:探讨急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者RALE评分与LUS评分在各个不同时间节点的相关性及其对预后的评估价值。方法:选择2021年9月—2022年6月于我院EICU就诊的ARDS患者。记录患者入ICU第24、48、72小时的RALE评分及LUS评分,根据第28 d的预后情况,将患者分为死亡组和存活组,并对RALE评分、LUS评分的变化趋势及组间差异进行分析;采用Pearson相关性分析比较RALE评分与LUS评分的相关性;采用受试者工作特性曲线分析入ICU第24、48、72小时的RALE评分和LUS评分预测ARDS患者28 d病死率。结果:最终入选70例患者,第28天共存活26例,死亡44例。入ICU时,死亡组患者的APACHEⅡ评分均显著高于存活组,第48及72小时氧合指数显著低于存活组,28 d无机械通气时间明显较短(P<0.05),其他基线指标差异均无统计学意义。随着住院时间的延长,存活组RALE评分和LUS评分均呈下降趋势,而死亡组则呈显著上升趋势;死亡组第24小时的RALE评分和LUS评分略高于存活组(RALE评分:17.00±10.36 vs.19.93±13.59;LUS评分:16.08±2.38 vs.19.50±3.11),差异无统计学意义;第48及72小时的RALE评分和LUS评分均明显高于存活组(RALE评分:13.96±7.03 vs.26.52±9.77,13.31±4.89 vs.30.25±8.09;LUS评分:10.50±1.94 vs.19.30±4.45,9.27±3.22 vs.22.14±4.71),均差异有统计学意义(P<0.05)。入ICU第48、72小时的RALE评分和LUS评分呈显著正相关(r值分别为0.554和0.570,P<0.001),而第24小时的RALE评分和LUS评分之间并无相关性。根据ROC曲线分析显示,第72小时的RALE评分及第48、72小时的LUS评分曲线下面积均大于0.85,对患者28 d病死率存在良好的预测价值(RALE评分的ROC曲线下面积分别为0.659、0.813、0.917,LUS评分别为0.827、0.958、0.971),差异有统计学意义(P<0.05)。结论:ARDS患者RALE评分与LUS评分具有相关性,并可进一步评估患者第28天的预后情况。

Objective:To investigate the correlation between radiographic assessment of lung edema(RALE)score and lung ultrasound score(LUS)at different time nodes and their prognostic value in patients with acute respiratory distress syndrome(ARDS).Methods:ARDS patients admitted to EICU of the People's Hospital from September 2021 to June 2022 were selected.The RALE score and LUS score were recorded at 24,48 and 72 hours after admission to ICU.According to the prognosis on the 28th day,the patients were divided into the death group and the survival group,and the changing trend of RALE score and LUS score and the differences between groups were analyzed.Pearson correlation analysis was used to compare the correlation between RALE score and LUS score.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of RALE score and LUS score at 24,48 and 72 hours after admission to ICU for 28-day mortality of ARDS patients.Results:Of the 70 patients enrolled,44 patients died and 26 patients survived on the 28th day.The APACHEI score of the patients in the death group were significantly higher than that in the survival group,the oxygenation index was significantly lower than that in the survival group,and the 28-day time without mechanical ventilation was significantly shorter(P<0.05).There were no statistically significant differences in other baseline indicators between the two groups.With the extension of treatment time,the RALE score and LUS score in the survival group showed a significant downward trend,while the LUS score in the death group showed a significant upward trend.The RALE score and LUS score at 24 hours were slightly higher in the death group than in the surviving group(RALE score:17.00±10.36 vs.19.93±13.59,LUS score:16.08±2.38 vs.19.50±3.11).The RALE score and LUS score at 24,48 and 72 hours in the death group were significantly higher than those in the survival group(RALE score:13.96±7.03 vs.26.52±9.77,13.31±4.89 vs.30.25±8.09;LUS score:10.50±1.94 vs.19.30±4.45,9.27±3.22 vs.22.14±4.71),the differences were statistically significant(P<0.05).There was a significant positive correlation between RALE score and LUS score at 48 and 72 hours after admission to ICU(r=0.554 and 0.570,P<0.001),the differences were statistically significant(P<0.001),but there was no correlation between RALE score and LUS score at 24hours after admission.ROC curve analysis showed that the area under the curve of RALE score at 72 hours,LUS score at 48 and 72 hours was greater than 0.85,which had predictive value for 28-day mortality(the area under the ROC curve of RALE score was 0.659,0.81,0.917,respectively;LUS scores were 0.827,0.958,0.971,respectively),and the differences were statistically significant(P<O.05).Conclusion:There is a correlation between RALE score and LUS score in ARDS patients,and RALE score can be used to evaluate the prognosis of ARDS patients at day 28.