肺损伤预测评分联合红细胞分布宽度预测急性呼吸窘迫综合征预后  

Prognostic value of lung injury prediction score combined with red blood cell distribution width in ARDS patients

作　　者：冯帆 冀志红 孟庆庆 常彩芳[1] FENG Fan;JI Zhihong;MENG Qingqing;CHANG Caifang(Department of Infectious Diseases,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]河北北方学院附属第一医院感染性疾病科,河北张家口075000

出　　处：《中国临床研究》2023年第4期553-557,共5页Chinese Journal of Clinical Research

摘　　要：目的探讨入院时肺损伤预测评分(LIPS)联合红细胞分布宽度(RDW)预测急性呼吸窘迫综合征(ARDS)患者短期死亡的临床价值。方法回顾性纳入2018年1月至2021年12月河北北方学院附属第一医院住院治疗的326例ARDS患者。根据28 d转归,分为死亡组130例(39.88%)、存活组196例(60.12%)。通过电子病历系统提取患者的临床资料,采用多因素logistic回归分析法筛选ARDS患者28 d死亡的危险因素,采用ROC曲线评定LIPS联合RDW预测ARDS患者死亡的临床价值。结果单因素比较显示,死亡组有糖尿病史、行肾脏替代治疗的比例以及入院时RDW、C反应蛋白、急性生理与慢性健康状况评分系统(APACHE)Ⅱ、LIPS均高于存活组,血白蛋白低于存活组(P<0.05)。多因素logistic回归结果显示,RDW(OR=1.486)、APACHEⅡ(OR=1.597)、LIPS(OR=1.711)增高是ARDS患者28 d死亡的独立危险因素(P<0.05)。ROC曲线分析显示,LIPS联合RDW预测的AUC为0.922,敏感性90.00%,特异性82.65%,优于RDW、APACHEⅡ、LIPS三指标单项以及APACHEⅡ+RDW联合预测的效能。结论LIPS评分、RDW水平升高是ARDS患者死亡的独立危险因素,联合应用可预测该类患者28 d全因死亡风险,可辅助临床医师对患者死亡风险进行识别分类,更高效管理患者。Objective To explore the clinical value of lung injury prediction score(LIPS)combined with red blood cell distribution width(RDW)for predicting short-term mortality in patients with acute respiratory distress syndrome(ARDS).Methods A total of 326 ARDS patients who were hospitalized in the First Affiliated Hospital of Hebei North University from January 2018 to December 2021 were retrospectively included.According to the 28-day outcome,the patients were divided into death group(n=130,39.88%)and survival group(n=196,60.12%).The clinical data of patients was extracted from the electronic medical record system,the risk factors of 28-day death in ARDS patients were screened by multivariate logistic regression analysis,and the clinical value of LIPS combined with RDW in predicting the death of ARDS patients was further evaluated by ROC curve analysis.Results Univariate analysis showed that the proportion of diabetes mellitus history and renal replacement therapy,RDW,C-reactive protein,APACHEⅡand LIPS at admission in death group were significantly higher than those in survival group,while albumin(Alb)was lower than that in survival group(P<0.05).Multivariate logistic regression analysis showed that increased RDW(OR=1.486),APACHEⅡ(OR=1.597),LIPS(OR=1.711)were the independent risk factors for 28-day death in ARDS patients.ROC curve analysis showed that the AUC by LIPS combined with RDW was 0.922,with sensitivity of 90.00%and specificity of 82.65%,which were statistically higher than those detected by alone RDW,APACHEⅡand LIPS indicators and by APACHEⅡcombined with RDW in predicting the outcome of ARDS patients.Conclusion Elevated LIPS score and RDW are independent risk factors for mortality in ARDS patients.Combined application of LIPS and RDW can predict the 28-day all-cause death risk of ARDS patients and assist clinicians in identifing and classifying mortality predictors so as to manage the patients more efficiently.

关 键 词：急性呼吸窘迫综合征 肺损伤 肺损伤预测评分 红细胞分布宽度 脓毒症 重症肺炎 

分 类 号：R563.8[医药卫生—呼吸系统]