Clinical study on extrtravascular lung water content and prognosis of patients with acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6880.2021.05.006

Abstract

Abstract:

Objective

To observe the prognostic value of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in patients with acute respiratory distress syndrome (ARDS) during hospitalization.

Methods

A total of 71 patients with ARDS admitted to the ICU of Qilu Hospital of Shandong University from January 2010 to December 2017 were retrospectively analyzed. According to their prognosis, 71 patients were divided into a living group (n = 29) and a death group (n = 42). The general data, fluid balance volume and mechanical ventilation settings were compared between the two groups. Multivariate Logistic regression was used to analyze risk factors influencing the prognosis of ARDS patients, and the receiver operating characteristic (ROC) curve was drawn to evaluate their diagnostic value.

Results

The age, immune dysfunction, septic shock, continuous renal replacement therapy(CRRT), lung-derived ARDS, severe ARDS, total fluid balance of 7 d, EVLWI and PVPI at the first 3 days, arterial partial pressure of carbon dioxide, airway peaks and oxygenation index were statistically significantly different between the living group and death group (all P < 0.05). Multivariate Logistic regression analysis showed that the age [odds ratio (OR) = 1.190, 95% confidence interval (CI) (1.053, 1.346), P = 0.005], immune dysfunction [OR = 0.076, 95%CI (0.006, 0.925), P = 0.011], EVLWI on day 1 [OR = 1.078, 95%CI (0.978, 1.188), P = 0.013], EVLWI on day 2 [OR = 1.109, 95%CI (1.014, 1.214), P = 0.023], EVLWI on day 3 [OR = 1.115, 95%CI (1.015, 1.226), P = 0.024], PVPI on day 1 [OR = 2.048, 95%CI (1.167, 3.595), P = 0.012], PVPI on day 2 [OR = 2.070, 95%CI (1.187, 3.611), P = 0.010], PVPI on day 3 [OR = 2.366, 95%CI (1.271, 4.404), P = 0.007] and oxygenation index [OR = 0.973, 95%CI (0.957, 0.989), P = 0.002] were independent risk factors influencing the prognosis of ARDS patients, while CRRT [OR = 10.404, 95%CI (1.709, 63.347), P = 0.001] was the protective factor. ROC curve analysis showed that the age [area under the curve (AUC) = 0.677, 95%CI (0.546, 0.809), P = 0.013], immune dysfunction [AUC = 0.641, 95%CI (0.512, 0.770), P = 0.048], CRRT [AUC = 0.711, 95%CI (0.573, 0.792), P = 0.046], EVLWI on day 1 [AUC = 0.743, 95%CI (0.607, 0.861), P = 0.001], EVLWI on day 2 [AUC = 0.763, 95%CI (0.641, 0.884), P < 0.001], EVLWI on day 3 [AUC = 0.734, 95%CI (0.613, 0.855), P = 0.001], PVPI on day 1 [AUC = 0.711, 95%CI (0.586, 0.837), P = 0.004], PVPI on day 2 [AUC = 0.755, 95%CI (0.633, 0.877), P < 0.001], PVPI on day 3 [AUC = 0.793, 95%CI (0.686, 0.901), P < 0.001] and oxygenation index [AUC = 0.687, 95%CI (0.611, 0.854), P = 0.041] all had certain predictive value for ARDS patients.

Conclusion

Age, immune dysfunction, CRRT, EVLWI, PVPI and oxygenation index are influencing factors for the prognosis of ARDS patients, and dynamic observation of EVLWI and PVPI changes is more significant in judging their prognosis.

Key words: Acute respiratory distress syndrome, Extravascular lung water index, Pulmonary vascular permeability index, Mechanical ventilation, Prognosis

Liyong Zong, Aimin Liu, Shifang Ding, Dawei Wu, Chen Li, Qian Zhai, Binfeng Du, Yuan Li. Clinical study on extrtravascular lung water content and prognosis of patients with acute respiratory distress syndrome[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(05): 380-385.

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References 18

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组别	例数	年龄（岁）	性别（例，男/女）	高血压史（例）	糖尿病史（例）	免疫功能低下病史（例）	脓毒性休克（例）	APACHEⅡ评分（分）	白细胞计数（× 10⁹/L）	C反应蛋白（μg/L）
存活组	29	50 ± 17	16/13	6	4	1	19	24 ± 7	13.7 ± 8.5	159 ± 82
死亡组	42	61 ± 17	30/12	13	8	13	38	26 ± 6	14.5 ± 8.8	192 ± 94
t/χ²/H值		2.560	1.923	0.881	0.316	8.144	7.315	1.226	0.039	1.056
P值		0.013	0.165	0.348	0.574	0.004	0.028	0.224	0.732	0.181
组别	例数	降钙素原[μg/L，M（P₂₅，P₇₅）]	CRRT（例）	肺源性ARDS（例）	重度ARDS（例）	乳酸（mmol/L）	7 d总液体平衡量[mL，M（P₂₅，P₇₅）]	第1天EVLWI（mL/kg）	第2天EVLWI（mL/kg）	第3天EVLWI（mL/kg）
存活组	29	9.6（0.5，10.0）	8	12	9	3.7 ± 2.9	4 280（1 212，7 080）	12.5 ± 7.6	12.4 ± 8.5	12.3 ± 5.2
死亡组	42	10.0（0.5，12.5）	20	32	31	3.3 ± 2.6	6 058（4 280，9 354）	18.2 ± 8.3	19.2 ± 9.7	20.0 ± 11.6
t/χ²/H值		0.450	2.818	6.419	12.032	0.591	0.952	2.912	3.034	3.242
P值		0.713	0.013	0.003	0.001	0.556	0.045	0.005	0.003	0.002
组别	例数	第1天PVPI	第2天PVPI	第3天PVPI	PaCO₂（mmHg）	气道峰压（cmH₂O）	潮气量（mL/kg PBW）	呼气末正压（cmH₂O）	氧合指数（mmHg）
存活组	29	2.4 ± 1.2	2.3 ± 1.3	2.1 ± 0.9	38 ± 10	25 ± 6	7.8 ± 1.1	9±4	144 ± 60
死亡组	42	3.6 ± 1.6	3.6 ± 1.7	3.9 ± 2.0	45 ± 19	29 ± 7	7.5 ± 1.3	11 ± 5	88 ± 44
t/χ²/H值		3.338	3.602	0.933	2.028	2.775	1.540	1.837	2.282
P值		0.001	0.001	0.034	0.046	0.005	0.253	0.071	0.026

组别	例数	年龄（岁）	性别（例，男/女）	高血压史（例）	糖尿病史（例）	免疫功能低下病史（例）	脓毒性休克（例）	APACHEⅡ评分（分）	白细胞计数（× 10⁹/L）	C反应蛋白（μg/L）
存活组	29	50 ± 17	16/13	6	4	1	19	24 ± 7	13.7 ± 8.5	159 ± 82
死亡组	42	61 ± 17	30/12	13	8	13	38	26 ± 6	14.5 ± 8.8	192 ± 94
t/χ²/H值		2.560	1.923	0.881	0.316	8.144	7.315	1.226	0.039	1.056
P值		0.013	0.165	0.348	0.574	0.004	0.028	0.224	0.732	0.181
组别	例数	降钙素原[μg/L，M（P₂₅，P₇₅）]	CRRT（例）	肺源性ARDS（例）	重度ARDS（例）	乳酸（mmol/L）	7 d总液体平衡量[mL，M（P₂₅，P₇₅）]	第1天EVLWI（mL/kg）	第2天EVLWI（mL/kg）	第3天EVLWI（mL/kg）
存活组	29	9.6（0.5，10.0）	8	12	9	3.7 ± 2.9	4 280（1 212，7 080）	12.5 ± 7.6	12.4 ± 8.5	12.3 ± 5.2
死亡组	42	10.0（0.5，12.5）	20	32	31	3.3 ± 2.6	6 058（4 280，9 354）	18.2 ± 8.3	19.2 ± 9.7	20.0 ± 11.6
t/χ²/H值		0.450	2.818	6.419	12.032	0.591	0.952	2.912	3.034	3.242
P值		0.713	0.013	0.003	0.001	0.556	0.045	0.005	0.003	0.002
组别	例数	第1天PVPI	第2天PVPI	第3天PVPI	PaCO₂（mmHg）	气道峰压（cmH₂O）	潮气量（mL/kg PBW）	呼气末正压（cmH₂O）	氧合指数（mmHg）
存活组	29	2.4 ± 1.2	2.3 ± 1.3	2.1 ± 0.9	38 ± 10	25 ± 6	7.8 ± 1.1	9±4	144 ± 60
死亡组	42	3.6 ± 1.6	3.6 ± 1.7	3.9 ± 2.0	45 ± 19	29 ± 7	7.5 ± 1.3	11 ± 5	88 ± 44
t/χ²/H值		3.338	3.602	0.933	2.028	2.775	1.540	1.837	2.282
P值		0.001	0.001	0.034	0.046	0.005	0.253	0.071	0.026

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄（岁）	0.174	0.063	7.756	0.005	1.190	1.053 ~ 1.346
免疫功能低下病史	2.574	1.273	4.085	0.011	0.076	0.006 ~ 0.925
脓毒性休克	0.583	2.905	0.040	0.841	0.558	0.002 ~ 55.637
CRRT	-2.342	0.992	6.458	0.001	10.404	1.709 ~ 63.347
肺源性ARDS	1.745	1.578	1.223	0.269	0.175	0.008 ~ 3.348
重度ARDS	0.621	1.379	0.203	0.652	1.861	0.125 ~ 27.750
7 d总液体平衡量（mL）	< 0.001	< 0.001	0.778	0.378	1.000	1.000 ~ 1.001
第1天EVLWI（mL/kg）	0.050	0.075	2.287	0.013	1.078	0.978 ~ 1.188
第2天EVLWI（mL/kg）	0.046	0.104	5.143	0.023	1.109	1.014 ~ 1.214
第3天EVLWI（mL/kg）	0.048	0.109	5.103	0.024	1.115	1.015 ~ 1.226
第1天PVPI	0.287	0.717	6.239	0.012	2.048	1.167 ~ 3.595
第2天PVPI	0.284	0.728	6.568	0.010	2.070	1.187 ~ 3.611
第3天PVPI	0.317	0.861	7.381	0.007	2.366	1.271 ~ 4.404
PaCO₂（mmHg）	-0.060	0.040	2.291	0.130	0.941	0.871 ~ 1.018
气道峰压（cmH₂O）	0.097	0.088	1.211	0.271	1.102	0.927 ~ 1.309
氧合指数（mmHg）	0.028	0.008	10.598	0.002	0.973	0.957 ~ 0.989

变量	回归系数	标准误	Wald值	P值	OR值	95%CI
年龄（岁）	0.174	0.063	7.756	0.005	1.190	1.053 ~ 1.346
免疫功能低下病史	2.574	1.273	4.085	0.011	0.076	0.006 ~ 0.925
脓毒性休克	0.583	2.905	0.040	0.841	0.558	0.002 ~ 55.637
CRRT	-2.342	0.992	6.458	0.001	10.404	1.709 ~ 63.347
肺源性ARDS	1.745	1.578	1.223	0.269	0.175	0.008 ~ 3.348
重度ARDS	0.621	1.379	0.203	0.652	1.861	0.125 ~ 27.750
7 d总液体平衡量（mL）	< 0.001	< 0.001	0.778	0.378	1.000	1.000 ~ 1.001
第1天EVLWI（mL/kg）	0.050	0.075	2.287	0.013	1.078	0.978 ~ 1.188
第2天EVLWI（mL/kg）	0.046	0.104	5.143	0.023	1.109	1.014 ~ 1.214
第3天EVLWI（mL/kg）	0.048	0.109	5.103	0.024	1.115	1.015 ~ 1.226
第1天PVPI	0.287	0.717	6.239	0.012	2.048	1.167 ~ 3.595
第2天PVPI	0.284	0.728	6.568	0.010	2.070	1.187 ~ 3.611
第3天PVPI	0.317	0.861	7.381	0.007	2.366	1.271 ~ 4.404
PaCO₂（mmHg）	-0.060	0.040	2.291	0.130	0.941	0.871 ~ 1.018
气道峰压（cmH₂O）	0.097	0.088	1.211	0.271	1.102	0.927 ~ 1.309
氧合指数（mmHg）	0.028	0.008	10.598	0.002	0.973	0.957 ~ 0.989

变量	AUC	95%CI	特异度（%）	敏感度（%）	P值
年龄（岁）	0.677	0.546 ~ 0.809	39.1	56.3	0.013
免疫功能低下病史	0.641	0.512 ~ 0.770	34.5	43.9	0.048
CRRT	0.711	0.573 ~ 0.792	39.2	59.2	0.046
第1天EVLWI（mL/kg）	0.743	0.607 ~ 0.861	30.8	49.3	0.001
第2天EVLWI（mL/kg）	0.763	0.641 ~ 0.884	30.9	49.4	< 0.001
第3天EVLWI（mL/kg）	0.734	0.613 ~ 0.855	30.8	49.7	0.001
第1天PVPI	0.711	0.586 ~ 0.837	29.8	49.4	0.004
第2天PVPI	0.755	0.633 ~ 0.877	30.2	50.1	< 0.001
第3天PVPI	0.793	0.686 ~ 0.901	30.3	50.6	< 0.001
氧合指数（mmHg）	0.687	0.611 ~ 0.854	38.4	57.1	0.041

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