Analysis on prognostic indicators of severe acute respiratory distress syndrome

Objective To determine the prognostic indicators of severe acute respiratory distress syndrome (ARDS) by comprehensive analysis. Methods The clinical data of 71 patients with ARDS admitted from Feb. 2012 to Apr. 2017 were retrospectively collected and analyzed. The acute pathophysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, occurrence of extrapulmonary organ dysfunction and mortality within 28d after final diagnosis were calculated. The risk factors were screened using the logistic regression analysis to construct the risk prediction model by dynamic recording and comparing the variation of each baseline index within 7 days, and ROC curve was used to evaluate the prediction efficiency of the model. Results Of the 71 cases analyzed, the overall mortality within 28d after final diagnosis was 57.7%(41/71). Single factor logistic regression analysis showed that the APACHE Ⅱ score, the occurrence of extrapulmonary organ dysfunction, the changing rate within 7 days of APACHE Ⅱ score, pH, CO2 partial pressure and oxygenation index were significantly related to mortality. Multiple logistic regression showed that the occurrence of extrapulmonary organ dysfunction and the changing rate within 7 days of APACHE Ⅱ score were the independent risk factors for the death of patients 28 days after admission. The prediction model of 28d mortality in ARDS patients was constructed using the single factor- and multiple logistic regression as covariant, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the model were 93.9%, 91.7%, 93.3% and 91.7%, respectively. Conclusions Occurrence of extrapulmonary organ dysfunction and changing rate within 7 days of APACHE Ⅱ score can be used as an indicator to evaluate the prognosis of patients with severe ARDS. DOI: 10.11855/j.issn.0577-7402.2018.02.1