[Risk factors analysis of acute respiratory distress syndrome in intensive care unit traumatic patients].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Oct; 30(10):978-982.ZW
To investigate the risk factors of acute respiratory distress syndrome (ARDS) occurrence in intensive care unit (ICU) traumatic patients.
Clinical data of traumatic patients in ICU of the People's Hospital of Liangping in Chongqing from January 1st, 2012 to June 30th, 2018 were retrospectively analyzed. According to the outcomes, the patients were divided into ARDS group and non-ARDS group. The differences of demographic indexes (gender, age), time of admission, type of injury, atrial fibrillation, trachea cannula, multiple injury, open injury, shock, surgery, blood transfusion, central venous indwelling catheter, infection, and blood routine indexes [white blood cell count (WBC), red blood cell count (RBC), platelet count (PLT), plateletcytocrit (PCT), hematocrit (Hct)], biochemical indexes [total bilirubin (TBil), albumin (Alb), serum creatinine (SCr), blood sodium, blood calcium, blood potassium, blood glucose], arterial blood gas analysis indexes [partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), blood pH], coagulation indicators [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), fibrinogen (Fib)], injury severity score (ISS), new injury severity score (NISS), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS) within 24 hours of admission, and the length of ICU stay between the two groups were analyzed, and the possible influencing factors were screened out. Logistic regression model was used to analyze the risk factors of ARDS in patients with severe trauma, and receiver operating characteristic curve (ROC) was drawn to evaluate its predictive value.
A total of 303 patients with severe trauma, including 223 males and 80 females, were enrolled. The average age was (52.98±17.03) years old. ARDS occurred in 149 cases (49.17%), including 114 males and 35 females. Compared with the non-ARDS group, the ARDS group had older age, higher rates of traffic injuries, endotracheal intubation and infection, higher blood sugar, PaO2/FiO2, TT, ISS, NISS and SOFA, lower GCS and longer the length of ICU stay. Logistic regression analysis showed that hyperglycemia, PaO2/FiO2 anomalies and increased SOFA score were independent risk factors for ARDS in ICU trauma patients [blood glucose > 6.10 mmol/L: odds ratios (OR) = 2.72, 95% confidence interval (95%CI) = 1.20-6.19, P = 0.017; PaO2/FiO2 < 400 mmHg (1 mmHg = 0.133 kPa): OR = 7.40, 95%CI = 1.59-34.37, P = 0.011; SOFA > 5: OR = 2.92, 95%CI = 1.63-5.21, P < 0.001]. ROC curve analysis showed that blood glucose, SOFA and PaO2/FiO2 could predict ARDS in ICU trauma patients, with the area under ROC curve (AUC) were 0.65, 0.70 and 0.75, respectively (all P < 0.01). The predictive value of PaO2/FiO2 was better, when the cut-off value was 275 mmHg, the sensitivity was 85.89% and specificity was 70.29%.
The traumatic patients on admission with hyperglycemia, abnormal PaO2/FiO2 and increased SOFA score are more susceptible to ARDS occurrence.