Chinese Journal of Respiratory and Critical Care Medicine
Supervisor：Ministry of Education of the People's Republic of ChinaSponsor：West China Medical Center & West China Hospital, Sichuan University Editor-in-chief：LIN Jiangtao / LIU Chuntao Publishing period：
Monthly
ISSN：1671-6205CN：51-1631/R
Objective To investigated the early risk factors of AIDS severe pneumonia complicated with acute respiratory distress syndrome in order to carry out early recognition and intervention of ARDS and improve the prognosis of patients. Methods The clinical data of 232 patients with severe AIDS pneumonia admitted to Chengdu Public Health Clinical Medical Center from January 2017 to December 2020 were retrospectively analyzed, including general data, vital signs, laboratory examination indexes, basic diseases, etc. Firstly influential indexes for complicated with ARDS were screened by single factor logistic regression analysis, then the multicollinearity assessment indicators were filtered out in multi-factor logistic stepwise regression analysis, finally the receiver operating characteristic (ROC) curves were drawn and the predictive value of the indicators were assessed. Results Thirty-three of 232 AIDS patients with severe pneumonia were complicated with ARDS. The mortality rate in ARDS group was 81.8%. The intra-group mortality of non-ARDS group was 33.7%. Single factor logistic regression analysis showed that pH, acute physiology and chronic health evaluation Ⅱ grade, sequential organ failure assessment grade, white blood cell count, lactate dehydrogenase, α-hydroxybutyric acid dehydrogenase (α-HBDH), alanine aminotransferase (ALT), aspartic acid aminotransferase (AST), calcium, fibrinogen degradation produc (FDP) and D-dimer, total 11 indicators were associated with the incidence of ARDS. The multicollinearity analysis of the 11 indicators showed that there was no multicollinearity problem among the other 9 indicators except the variance inflation factor of ALT and AST which was greater than 10. Multivariate logistic stepwise regression analysis showed α-HBDH (OR=1.001, 95% confidence interval 1.000 - 1.002, P=0.045) and D-dimer (OR=1.044, 95% confidence interval 1.006 - 1.083, P=0.024) were independent factors. ROC curve indicated the following: alpha hydroxy butyric acid dehydrogenase (the area under ROC curve=0.667, P=0.002, the optimal threshold was 391 U/L, the corresponding sensitivity and specificity was 78.8% and 61.8%, respectively), D-dimer (the area under ROC curve=0.602, P=0.062, the optimal threshold was 4.855 μg/mL, the corresponding sensitivity and specificity was 42.4% and 82.9%, respectively). Conclusion AIDS severe pneumonia complicated with ARDS is associated with many factors, among whichα-HBDH (≥391 U/L) and D-dimer (≥ 4.855 μg/mL) on admission are independent risk factors, which have great early predictive value and can provide reference for early clinical identification of ARDS high-risk patients.
Citation：ZHANG Lihui, CHEN Xuerong. Rrisk factors of acute respiratory distress syndrome in AIDS patients with severe pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(11): 761-767. doi: 10.7507/1671-6205.202210058Copy
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5. Chinh LQ, Manabe T, Son DN, et al. Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam. PloS One, 2019, 14(8): e0221114.
6. Seethala RR, Hou PC, Aisiku IP, et al. Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients. Ann Intensive Care, 2017, 7(1): 11.
9. Zhu GJ, Zhang K, Fu YX, et al. Accuracy assessment of noninvasive cardiac output monitoring in the hemodynamic monitoring in critically ill patients. Ann Palliat Med, 2020, 9(5): 3506-3512.
11. Jaiswar SP, Amrit G, Rekha S, et al. Lactic dehydrogenase: a biochemical marker for preeclampsia-eclampsia. Obstet Gynaecol India, 2011, 61(6): 645-648.
12. Rohit J, Chintan U, Latika M, et al. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia, Gujarat. Int J Reprod Contracept Obstet Gynecol, 2017, 6(8): 3418-3418.
15. Xiao WM, Liu WL, Yin L, et al. Serum hydroxybutyrate dehydrogenase as an early predictive marker of the severity of acute pancreatitis: a retrospective study. BMC gastroenterol, 2020, 20(1): 393.
17. Verni CC, Davila A, Sims CA, et al. D-dimer and fibrin degradation products impair platelet signaling: plasma D-dimer is a predictor and mediator of platelet dysfunction during trauma. J Appl Lab Med, 2020, 5(6): 1253-1264.
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Citation：ZHANG Lihui, CHEN Xuerong. Rrisk factors of acute respiratory distress syndrome in AIDS patients with severe pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(11): 761-767. doi: 10.7507/1671-6205.202210058
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