Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency
Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency
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ARDS 的预后因素：临床、生理和非典型免疫缺陷
DOI：
10.1186/s12890-020-1131-0
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发表时间：
2019-08
影响因子：
3.1
通讯作者：
Chen Ping
中科院分区：
文献类型：
--
作者：
Song Min;Liu Yijie;Lu Zhiwen;Luo Hong;Peng Hong;Chen Ping
目的探讨影响成人急性呼吸窘迫综合征（ARDS）预后的危险因素。其目的是确定新的预测ARDS患者的预后，包括那些与临床，病理生理，和非典型immunodeficiency.MethodsARDS患者进行了回顾性研究。根据不同的氧合指数等级和预后对患者进行分组分析，并检查影响预后和生存的因素。排除青少年患者、典型免疫缺陷患者和确诊ARDS后24 h内死亡的患者。死亡率的预测值由考克斯比例风险analysis.ResultsIn总数，201例患者符合柏林定义的ARDS。通过急性生理学和慢性健康评估（APACHE）II评分（P = 0.016）、序贯器官衰竭评估（SOFA）评分（P = 0.027）和PaO2/FiO2（P = 0.000）测量，入组当天危重疾病的严重程度从轻度恶化为重度ARDS病例。与幸存者相比，非幸存者年龄明显更大，APACHE II和SOFA评分更高。死亡组淋巴细胞/中性粒细胞比值和白细胞计数均显著低于存活组（P = 0.008，P = 0.012）。淋巴细胞/中性粒细胞与PaO2/FiO2比值呈中度正相关（P = 0.023）。在预测ARDS患者100天生存率时，淋巴细胞/中性粒细胞比值的曲线下面积（AUC）显著高于单独的PaO2/FiO2比值、单独的体重指数（BMI）和单独的淋巴细胞计数（P = 0.0062、0.0001和0.0154）。年龄（每log10岁）、BMI <24、SOFA评分、白细胞计数和淋巴细胞/中性粒细胞比值是ARDS患者28天死亡率的独立预测因素。此外，淋巴细胞/中性粒细胞比值<0.0537的ARDS患者28天死亡率增加（P = 0.0283）。结论年龄、BMI <24、SOFA评分、淋巴细胞、淋巴细胞/中性粒细胞比值是ARDS患者100 d死亡率的独立预测因子。淋巴细胞/中性粒细胞比值可能是评价ARDS患者非典型免疫抑制或免疫功能损害的潜在分子标志物。
BackgroundRisk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency.MethodsARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis.ResultsIn total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P= 0.016), Sequential Organ Failure Assessment (SOFA) score (P= 0.027), and PaO2/FiO2(P= 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P= 0.008,P= 0.012). A moderate positive correlation between the lymphocyte/neutrophil and PaO2/FiO2ratios (P= 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO2/FiO2ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P= 0.0062, 0.0001, and 0.0154). Age (per log10years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/neutrophil ratio < 0.0537 had increased 28-day mortality rates (P= 0.0283). Old age affected both 28-day and 100-day mortality rates (P= 0.0064,0.0057).ConclusionsAge (per log10years), BMI < 24, SOFA score, lymphocytes, and the lymphocyte/neutrophil ratio were independent predictors of 100-day mortality in patients with ARDS. The lymphocyte/neutrophil ratio may represent a potential molecular marker to evaluate atypical immunosuppression or impairment in patients with ARDS.
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影响因子：
5.3
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影响因子：
5.3
作者：
Shen XF;Cao K;Jiang JP;Guan WX;Du JF
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Du JF
影响因子：
4.3
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影响因子：
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影响因子：
5.4
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