急性呼吸窘迫综合征患者凝血指标与早期预后的关系

Relationship between coagulation indicators and early stage prognosis in patients with acute respiratory distress syndrome

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摘要目的探讨急性呼吸窘迫综合征(ARDS)患者凝血指标与早期预后的关系。方法从麻省理工学院、贝斯以色列女执事医疗中心和飞利浦医疗联合发布的重症医学开放数据库(MIMIC-ⅣV2.0版本)中选取2008-2019年在重症监护病房(ICU)接受治疗的ARDS患者,根据患者病情的严重程度和肺部受损的原因进行分类,对比不同ARDS患者凝血指标及28 d病死率(m28d)。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)评估相关指标的预测价值。单因素及多因素logistic回归分析影响ARDS患者m28d的危险因素。结果肺源性ARDS患者的凝血酶原时间最大值(PT_(max))明显低于非肺源性患者,差异有统计学意义(P<0.05);不同严重程度ARDS患者PLT_(min)、PLTmax、序贯性器官衰竭评估(SOFA)评分比较差异有统计学意义(P<0.05)。存活和死亡患者国际标准化比值最小值(INR_(min))、国际标准化比值最大值(INR_(max))、凝血酶原时间最小值(PT_(min))、PT_(max)、活化部分凝血活酶时间最大值(APTT_(max))、SOFA评分比较差异有统计学意义(P<0.05)。INRmin、INR_(max)、PT_(min)、PT_(max)、APTT_(max)预测ARDS患者早期预后的AUC分别为0.607、0.624、0.610、0.620及0.648(P<0.05)。多因素logistic回归分析显示,APTT_(max)(OR=1.011,95%CI:1.001~1.022,P=0.029)是影响ARDS患者m28d的独立危险因素。结论不同严重程度ARDS患者血浆PLT水平存在差异,入住ICU第1天APTT_(max)是影响ARDS患者早期预后的独立危险因素。 Objective To investigate the relationship between coagulation indicators and early prognosis in patients with acute respiratory distress syndrome(ARDS).Methods The data of ARDS patients receiving the treatment in the intensive care unit(ICU)from 2008-2019 were selected from the Critical Care Medicine Open Database(MIMIC-ⅣV2.0 version)jointly published by MIT,Beth Israel Deaconess Medical Center,and Philips Medical,the data were categorized according to the severity of the patients’disease and the causes of lung damage.The coagulation indexes and 28 d mortality(m28d)rates were compared among different ARDS patients.The receiver operating characteristic(ROC)curve was drawn.The area under the curve was calculated to evaluate the predictive values of the related indicators.The univariate and multivariate logistic regression was adopted to analyze the risk factors affecting m28d in the patients with ARDS.Results Maximum prothrombin time(PT_(max))in the patients with pulmonary origin ARDS was significantly lower than that in the patients without pulmonary origin ARDS,and the difference was statistically significant(P<0.05).PLTmin,PLTmax and Sequential Organ Failure Assessment(SOFA)score had statistical difference among different severity degrees of ARDS patients(P<0.05).Minimum international normalized ratio(INR_(min)),maximum international normalized ratio(INR_(max)),minimum prothrombin time(PT_(min)),PT_(max),maximum activated partial thromboplastin time(APTT_(max))and SOFA score had statistical differences between the survival group and death group(P<0.05).AUC of INR_(min),INR_(max),PT_(min),PT_(max) and APTT_(max) were 0.607,0.624,0.610,0.620 and 0.648 respectively.The multivariate logistic regression analysis showed that APTT_(max)(OR=1.011,95%CI:1.001-1.022,P=0.029)was an independent risk factor for affecting m28d in the ARDS patients.Conclusion Plasma PLT levels in different severities of ARDS patients have the difference and APTT_(max) on the first day in ICU is an independent risk factor for affecting earl

作者靳小二普玉凡王淼薛春萌廖清波丁琦 JIN Xiao’er;PU Yufan;WANG Miao;XUE Chunmeng;LIAO Qingbo;DING Qi(Department of Emergency,Affiliated Suzhou Hospital of Nanjing Medical University/Suzhou Municipal Hospital,Suzhou,Jiangsu 215000,China;Gusu School,Nanjing Medical University,Suzhou,Jiangsu 215000,China)

机构地区南京医科大学附属苏州医院/苏州市立医院急诊科南京医科大学姑苏学院

出处《重庆医学》 CAS 2024年第15期2296-2300,2307,共6页 Chongqing Medical Journal

基金苏州卫健委姑苏人才项目(GSWS2020065)。

关键词急性呼吸窘迫综合征凝血参数早期预后 acute respiratory distress syndrome coagulation indicators early prognosi

分类号 R563.9 [医药卫生—呼吸系统]