高密度脂蛋白水平对脓毒症相关急性呼吸窘迫综合征患者预后的影响

Effect of high density lipoprotein level on prognosis of sepsis-related acute respiratory distress syndrome

目的 评价高密度脂蛋白(HDL)水平对脓毒症相关急性呼吸窘迫综合征(ARDS)预后的影响。方法 采用回顾性研究,选取2016年6月至2023年6月航天中心医院重症医学科收治的102例脓毒症相关ARDS患者为观察对象,按患者入院28 d预后将其分为存活组(n=46)、死亡组(n=56)。分析所有患者的性别、年龄、原发感染部位、既往史、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、呼吸频率、体温、胆固醇、甘油三酯、白蛋白、HDL、低密度脂蛋白(LDL)、降钙素原、C反应蛋白(CRP)、白细胞、是否使用呼吸机、住院时是否合并感染性休克以及抗细菌和抗真菌治疗等资料,经单因素、多因素分析脓毒症相关ARDS患者预后的危险因素。采用受试者工作特征(ROC)曲线分析HDL水平对脓毒症相关ARDS死亡患者发生的预测效能。结果 (1)102例脓毒症相关ARDS患者病死率为54.90%。(2)死亡组患者的年龄、APACHEⅡ评分、使用呼吸机比例、合并感染性休克比例分别为(72.59±14.86)岁、26.50分、80.36%、73.21%,均显著高于存活组[(64.43±15.86)岁、20.00分、69.57%、36.96%],外周血HDL水平为(0.60±0.25) mmol/L,低于ARDS存活组[(0.90±0.33) mmol/L],差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,高APACHEⅡ评分(OR=0.88,95%CI:0.81~0.95,P=0.002)、合并感染性休克(OR=0.25,95%CI:0.08~0.76,P=0.014)、低水平的HDL(OR=4.46,95%CI:2.34~8.48,P=0.001)是脓毒症相关ARDS患者死亡的独立危险因素。(3)HDL预测脓毒症相关ARDS患者死亡的ROC的曲线下面积(AUC)为0.755,以HDL 0.735 mmol/L作为预测ARDS死亡的临界点,其敏感度为71.74%,特异度为73.21%。结论 低水平的HDL是脓毒症相关ARDS死亡的独立危险因素,HDL水平对脓毒症相关ARDS患者的预后有一定的预测价值。

Objective To evaluate the effect of high density lipoprotein(HDL) levels on the prognosis of sepsis-related acute respiratory distress syndrome(ARDS).Methods A total of 102 patients with sepsis-related ARDS admitted to Department of Critical Care Medicine,Aerospace Center Hospital from June 2016 to June 2023 were divided into survival group(n=46) and death group(n=56) according to their 28-day prognosis after admission.Gender,age,primary infection site,past history,acute physiology and chronic health status evaluation Ⅱ(APACHE Ⅱ) score,respiratory rate,body temperature,cholesterol,triglycerides,albumin,HDL,low-density lipoprotein(LDL),procalcitonin,C-reactive protein(CRP),white blood cells,use of a ventilator,presence of septic shock during hospitalization,and antibacterial and antifungal therapy were retrospectively analyzed in all enrolled patients.The risk factors of prognosis in patients with sepsis and ARDS were analyzed by univariate and multivariate analysis,and the predictive efficacy of HDL level in patients with ARDS death associated with sepsis was analyzed by receiver operating characteristic(ROC) curve.Results The mortality rate of 102 patients with sepsis related ARDS was 54.90%.The age,APACHE Ⅱ score,the proportion of ventilator use and the proportion of septic shock in the death group were(72.59±14.86) years,26.50 scores,80.36%,73.21%,which were significantly higher than those in the survival group[(64.43±15.86) years,20.00 scores,69.57%,36.96%],and the level of peripheral blood HDL was(0.60±0.25) mmol/L,which was lower than that in the survival group[(0.90±0.33) mmol/L],the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that high APACHE Ⅱ score(OR=0.88,95%CI:0.81-0.95,P=0.002),combined with septic shock(OR=0.25,95%CI=0.08-0.76,P=0.014) and l low level of HDL(OR=4.46,95%CI:2.34-8.48,P=0.001) were risk factors for death in patients with sepsis associated ARDS.The area under the curve(AUC) of HDL for predicting the death of patients with sepsis complicated with ARDS was 0.755,and the critical point for predicting the death of ARDS was 0.735 mmol/L with a sensitivity of 71.74% and specificity of 73.21%.Conclusion Low level of HDL is a risk factor for sepsis-related ARDS death,and HDL level can predict the prognosis of patients with sepsis complicated with ARDS.