Noninvasive prediction of 28-day mortality in patients with sepsis associated acute respiratory distress syndrome
Objective To analyze the relationships between serum lactate(Lac),D-dimer(D-D),soluble thrombomodulin(sTM),and endothelium-specific molecule-1(ESM-1)levels and 28-day mortality in patients with sepsis associated acute respiratory distress syndrome(SAARDS).Methods This was a cohort study.A total of 375 SAARDS patients treated in Tianjin First Central Hospital and Special Medical Center of Armed Police from January 2018 to January 2023 were selected as the study objects,including 198 males and 177 females,aged(65.26±11.35)years.According to the oxygenation index(OI)at admission,the patients were divided into a mild group[96 cases,OI＞200 mmHg(1 mmHg=0.133 kPa)],a moderate group(152 cases,OI＞100-200 mmHg),and a severe group(127 cases,OI ≤100 mmHg).They were divided into a survival group(238 cases)and a death group(137 cases)according to the survival conditions within 28 days.Spearman correlation coefficient was used to analyze the correlations between OI and serum Lac,D-D,sTM,and ESM-1 levels in SAARDS patients.Multivariate logistic regression analysis was used to analyze the independent risk factors affecting the prognosis in SAARDS patients,and the predictive value of the risk factors was analyzed using the receiver operating characteristic curve(ROC).For the measurement data conforming to normal distribution,t test was used for comparison between two groups,F test was used for comparison among multiple groups,and SNK method was used for pairwise comparison.Kruskal-Wallis test was used for the measurement data conforming to non-normal distribution,and Bonferroni correction was used for pairwise comparison.The count data were measured using x2 test.Results Serum Lac,D-D,sTM,and ESM-1 levels were increased sequentially in the mild group,moderate group,and severe group(all P＜0.001).Serum Lac,D-D,sTM,and ESM-1 levels were negatively correlated with OI(r=-0.6 63,-0.664,-0.690,and-0.68 2,all P＜0.001).The proportions of septic shock,ICU time ≥10 days,and mechanical ventilation time ≥3 days,the levels of age,D-D,sTM,Lac,and ESM-1,and the Sepsis-Related Organ Failure Assessment(SOFA)score of the death group were higher than those of the survival group[65.69％(90/137)vs.52.10％(124/238),63.50％(87/137)vs.52.10％(124/238),58.39％(80/137)vs.47.06％(112/238),(66.24±4.73)years old vs.(64.87±6.07)years old,(3.59±0.84)mg/L vs.(2.87±0.70)mg/L,(125.77± 19.25)μg/L vs.(102.29±20.94)μg/L,8.39(7.31,8.84)mmol/L vs.5.62(4.11,8.04)mmol/L,3.91(3.20,4.48)μg/L vs.2.9 2(2.31,3.47)μg/L,14.00(12.00,17.0 0)points vs.12.00(10.00,13.00)points],but the OI was significantly lower than that of the survival group[92.74(82.83,156.64)mmHg vs.183.87(137.68,254.56)mmHg],with statistically significant differences(x2=5.675,4.594,and 4.471,t=2.439,9.232,and 10.767,Z=9.199,9.319,7.270,and 8.723;all P＜0.05).Multivariate logistic regression analysis showed that septic shock,SOFA score,Lac,D-D,sTM,and ESM-1 were independent risk factors for poor prognosis in SAARDS patients(OR=2.625,3.410,1.461,2.231,1.048,1.316,all P＜0.05),while OI was an independent protective factor(OR=0.978,P＜0.05).ROC analysis showed that serum Lac[area under the curve(AUC)=0.786],D-D(AUC=0.748),sTM(AUC=0.797),and ESM-1(AUC=0.788)in SAARDS patients had certain predictive value for death within 28 days.The AUC of combined prediction of the four was 0.908,which was higher than that of any single index(P＜0.001).Conclusion Serum Lac,D-D,sTM,and ESM-1 levels are independent risk factors for 28-day death in SAARDS patients,and have certain predictive value for 28-day death.
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