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Intens Care Med:危重脓毒症患者急性呼吸窘迫综合征导致的死亡分析

2020-04-12 MedSci原创 MedSci原创

入住ICU的脓毒症患者发生ARDS,除了增加其他重要预后外,还会增加ICU和住院死亡的风险。

以前评估急性呼吸窘迫综合征(ARDS)对死亡率影响的研究结果相互矛盾。近日,危重病医学领域权威杂志Intensive Care Medicine上发表了一篇研究文章,研究人员旨在评估入住重症监护病房(ICU)的脓毒症患者ARDS与住院死亡率之间的相关性。

研究人员分析了来自早期肾和肺损伤评估(EARLI;n=474)和验证急性肺损伤的诊断标记(VALID;n=337)试验中组建脓毒症患者前瞻性队列。ARDS根据Berlin标准来确定。研究人员使用logistic回归来比较ARDS患者和无ARDS患者的住院死亡率,并调整了基线疾病严重程度。研究人员还根据疾病严重程度进行了分层,并估计了归因死亡率。

EARLI队列中ARDS患者有195例(41%),VALID队列中ARDS患者有99例(29%)。即使在控制了通过APACHE II(EARLI中比值比[OR]为1.65(95%置信区间[CI]为1.02-2.67),p=0.04;VALID中OR为2.12 (95%CI为1.16-3.92),p=0.02)来衡量的疾病严重程度之后,在多变量分析中ARDS也独立地与医院死亡风险相关。严重ARDS患者(P/F<100)是这种关系的主要驱动因素。ARDS的归因死亡率在EARLI队列中为27% (CI为14%-37%),VALID队列中为37% (CI为10%-51%)。ARDS与ICU死亡率、住院时间(LOS)、ICU住院时间和无呼吸机天数独立相关。

由此可见,入住ICU的脓毒症患者发生ARDS,除了增加其他重要结局外,还会增加ICU和住院死亡的风险。

原始出处:

Catherine L. Auriemma.et al.Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis.Intensive Care Medicine.2020.https://www.esicm.org/icm-search/?id=doi:10.1007/s00134-020-06010-9#article

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