Clinical predictors of and mortality in acute respiratory distress syndrome: Potential role of red cell transfusion
Clinical predictors of and mortality in acute respiratory distress syndrome: Potential role of red cell transfusion
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DOI：
10.1097/01.ccm.0000165566.82925.14
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发表时间：
2005-06-01
影响因子：
8.8
通讯作者：
Christiani, DC
中科院分区：
文献类型：
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作者：
Gong, MN;Thompson, BT;Christiani, DC
目的：对急性呼吸窘迫综合征(ARDS)的临床预测因素进行前瞻性研究的较少。尽管输血在重症监护病房中很常见，但亚大规模输血在非创伤相关性ARDS中的作用尚未被研究。我们在这里描述了ARDS风险和死亡率的临床预测因素，包括红细胞输注的作用。设计：观察性前瞻性队列。马萨诸塞州综合医院的重症监护室。患者：我们研究了688例脓毒症、创伤、吸入和输血过多的患者。干预：无。测量和主要结果：221名(32%)受试者发生急性呼吸窘迫综合征，60天死亡率为46%。多因素分析显示，创伤(调整优势比[ORADJ]0.22，95%可信区间[CI]0.09~0.53)、糖尿病(ORADJ 0.58，95%CI 0.36~0.92)、直接肺损伤(ORADJ 3.78，95%CI 2.45~5.81)、血液衰竭(ORADJ 1.84，95%CI 1.05~3.21)、转院(ORADJ 2.08，95%CI 1.33~3.25)、呼吸频率和GT是ARDS的显著预测因素；33次/分钟(ORADJ 2.39，95%CI 1.51-3.78)，红细胞压积37.5%(ORADI 1.77，95%CI 1.14-2.77)，动脉pH值7.33(ORADJ 2.00，95%CI 1.31-3.05)，以及白蛋白
Objective: Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS risk and mortality including the role of red cell transfusion.Design: Observational prospective cohort.Setting. Intensive care unit of Massachusetts General Hospital. Patients: We studied 688 patients with sepsis, trauma, aspiration, and hypertransfusion.Interventions: None.Measurements and Main Results: Two hundred twenty-one (32%) subjects developed ARDS with a 60-day mortality rate of 46%. Significant predictors for ARDS on multivariate analyses included trauma (adjusted odds ratio [ORadj] 0.22, 95% confidence interval [CI] 0.09-0.53), diabetes (ORadj 0.58, 95% Cl 0.36-0.92), direct pulmonary injury (ORadj 3.78, 95% CI 2.45-5.81), hematologic failure (ORadj 1.84, 95% CI 1.05-3.21), transfer from another hospital (ORadj 2.08, 95% CI 1.33-3.25), respiratory rate > 33 breaths/min (ORadj 2.39, 95% CI 1.51-3.78), hematocrit > 37.5% (ORadi 1.77, 95% CI 1.14-2.77), arterial pH < 7.33 (ORadj 2.00, 95% CI 1.31-3.05), and albumin