Analysis of the risk factors of acute respiratory distress syndrome in patients with severe pneumonia in intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHAO Jingjing , ZHOU Xiaomei ,  YAO Li

Department of Intensive Care Medicine, Hefei No.2 People Hospital, Hefei, Anhui 230000, P. R. China;

Corresponding?author：

YAO Li, Email: ylirn168@163.com

Keywords：

Severe pneumonia; Acute respiratory distress syndrome; Lung injury prediction score; Pneumonia severity index score; Risk factor

DOI：

10.7507/1671-6205.201801035

Video：

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ObjectiveTo discuss the risk factors of acute respiratory distress syndrome (ARDS) in patients with severe pneumonia.MethodsData of 80 patients with severe pneumonia admitted in our ICU were analyzed retrospectively, and they were divided into two groups according to development of ARDS, which was defined according to the Berlin new definition. The age, gender, weight, Acute Physiology and Chronic Health EvaluationⅡscore, lactate, PSI score and LIPS score, etc. were collected. Statistical significance results were evaluated by multivariate logistic regression analysis after univariate analysis. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the parameter for ARDS after severe pneumonia.ResultsForty patients with severe pneumonia progressed to ARDS, there were 4 moderate cases and 36 severe cases according to diagnostic criteria. Univariate analysis showed that procalcitonin (t=4.08, P<0.001), PSI score (t=10.67, P<0.001), LIPS score (t=5.14, P<0.001), shock (χ²=11.11, P<0.001), albumin level (t=3.34, P=0.001) were related to ARDS. Multivariate logistic regression analysis showed that LIPS ［odds ratio (OR) 0.226, 95%CI=4.62-5.53, P=0.013］ and PSI (OR=0.854, 95%CI=132.2-145.5, P=0.014) were independent risk factors for ARDS. The predictive value of LIPS and PSI in ARDS occurrence was significant. The area under ROC curve (AUC) of LIPS was 0.901, the cut-off value was 7.2, when LIPS ≥7.2, the sensitivity and specificity were both 85.0%. AUC of PSI was 0.947, the cut-off value was 150.5, when PSI score ≥150.5, the sensitivity and specificity were 87.5% and 90.0% respectively.ConclusionsPSI and LIPS are independent risk factors of ARDS in patients with severe pneumonia, which may be references for guiding clinicians to make an early diagnosis and treatment plan.

Citation： ZHAO Jingjing, ZHOU Xiaomei, YAO Li. Analysis of the risk factors of acute respiratory distress syndrome in patients with severe pneumonia in intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 561-564. doi: 10.7507/1671-6205.201801035 Copy

1.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
2.	Gibelin A, Parrot A, Maitre B, et al. Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin Definition. Intensive Care Med, 2016, 42(2): 164-172.
3.	Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care, 2017, 7(1): 11.
4.	中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
5.	Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
6.	張志強, 馬海英, 馮憲軍. 重癥肺炎合并嚴重急性呼吸窘迫綜合征預后及危險因素患者的臨床特征. 中華醫院感染學雜志, 2016, 26(6): 111-113.
7.	Cilloniz C, Ferrer M, Liapikou A, et al. Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia. Eur Respir J, 2018, 51(3): pii: 1702215.
8.	Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries. JAMA, 2016, 315(8): 788-800.
9.	Luo J, Yu H, Hu YH, et al. Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study. J Thorac Dis, 2017, 9(10): 3979-3995.
10.	Luo L, Shaver CM, Zhao ZG, et al. Clinical predictors of hospital mortality differ between direct and indirect ARDS. Chest, 2017, 151(4): 755-763.
11.	Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann intensive care, 2017, 7(1): 11.
12.	李曉如, 李志軍, 王東. APACHEⅢ評分及 PSI 評分評估老年重癥肺炎預后的對比研究. 中國急救醫學, 2015, 11, 35(11): 1013-1016.
13.	Murray JF, Matthay MA, Luce JM, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis, 1988, 138(3): 720-723.
14.	Kangelaris KN, Calfee CS, May AK, et al. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?. Ann Intensive Care, 2014, 4(1): 4.
15.	Bauman ZM, Gassner MY, Coughlin MA, et al. Lung injury prediction score is useful in predicting acute respiratory distress syndrome and mortality in surgical critical care patients. Crit Care Res Pract, 2015, 2015: 157408.
16.	徐沖, 董麗霞, 曹潔. 降鈣素原在社區獲得性肺炎預后評估中的價值. 中國呼吸與危重癥監護雜志, 2017, 16(2): 117-121.
17.	李敏豪, 董超, 吳乾龍, 等. 血清降鈣素原對小兒細菌性重癥肺炎及并發急性呼吸窘迫綜合征的預測價值. 中華臨床醫師雜志: 電子版, 2015, 9(12): 2300-2303.
18.	Cheng SC, Scicluna BP, Arts RJ, et al. Broad defects in the energy metabolism of leukocytes underlie immunoparalysis in sepsis. Nat Immunol, 2016, 17(4): 406-413.

1. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
2. Gibelin A, Parrot A, Maitre B, et al. Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin Definition. Intensive Care Med, 2016, 42(2): 164-172.
3. Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care, 2017, 7(1): 11.
4. 中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 2016, 39(4): 253-279.
5. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
6. 張志強, 馬海英, 馮憲軍. 重癥肺炎合并嚴重急性呼吸窘迫綜合征預后及危險因素患者的臨床特征. 中華醫院感染學雜志, 2016, 26(6): 111-113.
7. Cilloniz C, Ferrer M, Liapikou A, et al. Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia. Eur Respir J, 2018, 51(3): pii: 1702215.
8. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 Countries. JAMA, 2016, 315(8): 788-800.
9. Luo J, Yu H, Hu YH, et al. Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study. J Thorac Dis, 2017, 9(10): 3979-3995.
10. Luo L, Shaver CM, Zhao ZG, et al. Clinical predictors of hospital mortality differ between direct and indirect ARDS. Chest, 2017, 151(4): 755-763.
11. Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann intensive care, 2017, 7(1): 11.
12. 李曉如, 李志軍, 王東. APACHEⅢ評分及 PSI 評分評估老年重癥肺炎預后的對比研究. 中國急救醫學, 2015, 11, 35(11): 1013-1016.
13. Murray JF, Matthay MA, Luce JM, et al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis, 1988, 138(3): 720-723.
14. Kangelaris KN, Calfee CS, May AK, et al. Is there still a role for the lung injury score in the era of the Berlin definition ARDS?. Ann Intensive Care, 2014, 4(1): 4.
15. Bauman ZM, Gassner MY, Coughlin MA, et al. Lung injury prediction score is useful in predicting acute respiratory distress syndrome and mortality in surgical critical care patients. Crit Care Res Pract, 2015, 2015: 157408.
16. 徐沖, 董麗霞, 曹潔. 降鈣素原在社區獲得性肺炎預后評估中的價值. 中國呼吸與危重癥監護雜志, 2017, 16(2): 117-121.
17. 李敏豪, 董超, 吳乾龍, 等. 血清降鈣素原對小兒細菌性重癥肺炎及并發急性呼吸窘迫綜合征的預測價值. 中華臨床醫師雜志: 電子版, 2015, 9(12): 2300-2303.
18. Cheng SC, Scicluna BP, Arts RJ, et al. Broad defects in the energy metabolism of leukocytes underlie immunoparalysis in sepsis. Nat Immunol, 2016, 17(4): 406-413.

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