Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study
Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study
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DOI：
10.1007/s00134-015-4046-0
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发表时间：
2015-11-01
影响因子：
38.9
通讯作者：
Thompson, Taylor B.
中科院分区：
文献类型：
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作者：
Lorente, Jose A.;Cardinal-Fernandez, Pablo;Thompson, Taylor B.
为了证明在急性呼吸窘迫综合征 (ARDS) 患者中，组织学检查时存在弥漫性肺泡损伤 (DAD) 与不存在弥漫性肺泡损伤 (DAD) 相比，定义了一种特定的亚表型。我们研究了 149 名在我们的 ICU 死亡、根据柏林定义 (BD) 临床诊断为 ARDS 并接受尸检的患者。我们比较了患有 DAD 的患者 (n = 49) 和没有 DAD 的患者 (n = 100) 的不同临床变量随时间的变化。在一个由 57 名 ARDS 患者和尸检（其中 21 名患有 DAD）组成的独立队列中开发并验证了 DAD 存在的预测模型。与无 DAD 的患者相比，DAD 患者的 PaO2/FiO(2) 比值和动态呼吸系统顺应性较低，SOFA 评分和 INR 较高，并且更有可能死于低氧血症，而不太可能死于休克。在多变量分析中，与 DAD [优势比，95% 置信区间 (CI)] 相关的变量为 PaO2/FiO(2) 比值 [0.988 (0.981-0.995)]、动态呼吸系统顺应性 [0.937 (0.892-0.984)] 和年龄 [0.972 (0.946-0.999)]。使用回归模型或 BD 对 DAD 进行分类的 ROC 曲线下面积 (95% CI) 分别为 0.74 (0.65-0.82) 和 0.64 (0.55-0.72) (p = 0.03)。在验证队列中，回归模型和 BD 诊断 DAD 的 ROC 曲线下面积分别为 0.73 (0.56-0.90) 和 0.67 (0.54-0.81)。DAD 的存在似乎定义了 ARDS 患者的特定亚表型。针对临床诊断为 ARDS 的患者群体中的 DAD 患者可能适合寻找治疗这种疾病的有效疗法。
To demonstrate that among patients with acute respiratory distress syndrome (ARDS), the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a specific subphenotype.We studied 149 patients who died in our ICU with the clinical diagnosis of ARDS according to the Berlin Definition (BD) and who had autopsy examination. We compared the change over time of different clinical variables in patients with (n = 49) and without (n = 100) DAD. A predictive model for the presence of DAD was developed and validated in an independent cohort of 57 patients with ARDS and postmortem examination (21 of them with DAD).Patients with DAD, as compared to patients without DAD, had a lower PaO2/FiO(2) ratio and dynamic respiratory system compliance, and a higher SOFA score and INR, and were more likely to die of hypoxemia and less likely to die of shock. In multivariate analysis, variables associated with DAD [odds ratio, 95 % confidence interval (CI)] were PaO2/FiO(2) ratio [0.988 (0.981-0.995)], dynamic respiratory system compliance [0.937 (0.892-0.984)] and age [0.972 (0.946-0.999)]. Areas under the ROC curve (95 % CI) for the classification of DAD using the regression model or the BD were, respectively, 0.74 (0.65-0.82) and 0.64 (0.55-0.72) (p = 0.03). In the validation cohort, the areas under the ROC curve for the diagnosis of DAD were 0.73 (0.56-0.90) and 0.67 (0.54-0.81) for the regression model and the BD, respectively.The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition.