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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 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.	张志强, 马海英, 冯宪军. 重症肺炎合并严重急性呼吸窘迫综合征预后及危险因素患者的临床特征. 中华医院感染学杂志, 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.	李晓如, 李志军, 王东. APACHEⅢ评分及 PSI 评分评估老年重症肺炎预后的对比研究. 中国急救医学, 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.	徐冲, 董丽霞, 曹洁. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重症监护杂志, 2017, 16(2): 117-121.
17.	李敏豪, 董超, 吴乾龙, 等. 血清降钙素原对小儿细菌性重症肺炎及并发急性呼吸窘迫综合征的预测价值. 中华临床医师杂志: 电子版, 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. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 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. 张志强, 马海英, 冯宪军. 重症肺炎合并严重急性呼吸窘迫综合征预后及危险因素患者的临床特征. 中华医院感染学杂志, 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. 李晓如, 李志军, 王东. APACHEⅢ评分及 PSI 评分评估老年重症肺炎预后的对比研究. 中国急救医学, 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. 徐冲, 董丽霞, 曹洁. 降钙素原在社区获得性肺炎预后评估中的价值. 中国呼吸与危重症监护杂志, 2017, 16(2): 117-121.
17. 李敏豪, 董超, 吴乾龙, 等. 血清降钙素原对小儿细菌性重症肺炎及并发急性呼吸窘迫综合征的预测价值. 中华临床医师杂志: 电子版, 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.

Previous Article
A preliminary study on the diagnosis of asthma-COPD overlap syndrome by different criteria
Next Article
Pulmonary actinomycosis: three cases report and review of the literature

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of the risk factors of acute respiratory distress syndrome in patients with severe pneumonia in intensive care unit

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content