Study On The Prediction Of ARDS In Clinical And Serological Markers

Background and Objective:Acute respiratory distress syndrome is a syndrome of acute respiratory failure characterized by various factors.It is mainly characterized by diffuse alveolar capillary membrane injury.It has a rapid onset,rapid progression and high mortality.Although the clinical strategy of ARDS has been improved in recent years,it still can not significantly reduce the mortality rate.So how to identify high-risk patients for early ARDS,and the occurrence and development of ARDS,the prognosis can be predicted,and the early warning,early intervention and treatment,may become an important method to reduce the mortality.But at present,there is no ideal index system.Many studies have shown that the use of a single index or only the use of clinical data for the prediction of ARDS has some limitations,can not get an ideal prediction model.This study attempts to establish a prospective,cohort study,to explore the predictive value of various indicators of ARDS occurrence,development and prognosis from two aspects of clinical indices and serological biomarkers,in order to provide the reference for clinical.Objects and Methods:The first part: this part is prospective,cohort study,from January 2013 to March 2016 in our hospital department of respiration ARDS patients and ARDS high-risk patients.Signed informed consent.Collect their general information.Within 24 hours of the completion of the APACHEII score,coagulation of blood,blood,inflammatory markers,arterial blood gas detection,take the difference between the six.To observe the survival status of 24 patients with ARDS.The second part: this part is prospective,multi center,cohort study,from January 2014 to March 2016 in Department of respiration,Southwest Hospital,Daping Hospital,ICU1,Daping Hospital ICU2 patients with EICU.After signing the informed consent,collect their general information.The APACHEII score and arterial blood gas were measured within 24 hours.The survival rate of 24 patients with plasma was collected.The APACHEII score and blood gas were measured at 24 hours,and the plasma was collected.ELISA detection of plasma sRAGE,CC16,Ang-2,sICAM-1,PAI-1,SuPAR,HMGB-1.To observe the survival status of 24 patients with ARDS.Results:The first part: 1.66 high risk cases,and 64 patients of ARDS(with a total of 28 deaths,with a survival of 36 cases)were included in the study.2 the combination of hypoproteinemia,fibrinogen,APACHEII score,D-two,and white blood cell count were independent risk factors for ARDS.3 oxygenation index,platelet and hypoproteinemia were independent risk factors for ARDS death.4 early warning,APACHE II score,hypoproteinemia,FIB predictive specificity can reach about 95%.The predictive sensitivity of D-two and hypoproteinemia was about 80%.In the aspect of prognosis,the specificity of platelet prediction was 75%,and the predictive sensitivity of hypoproteinemia was up to 92.9%.Joint prediction can improve the specificity of prediction,and decrease the sensitivity.The second part: 1 high-risk patients with,ARDS patients in 59 cases(26 cases of death,survival in 33 cases).2.lgsICAM-1,lgAng-2,lgCC16,lgHMGB-1,lgPAI-1 these 5 indicators are independent risk factors for ARDS.3.lgsRAGE and lgAng-2(OR=9.447)are independent risk factors for ARDS death.4 in the early warning analysis,HMGB1 and Ang-2 joint prediction,specificity to 95.1%.The combination of HMGB1,Ang-2 and PAI-1 three can improve the sensitivity of prediction to 89.8%.In the analysis of prognosis,the combination of sRAGE and Ang-2 can improve the specificity to 87.9%.Joint prediction can improve the sensitivity and specificity to some extent.5.lgSuPAR was negatively correlated with oxygenation index.LgAng-2 and lgPAI-1 were positively correlated with APACHEII score.6 the appearance of ARDS pulmonary vascular endothelial cell injury is more serious.7.Ang-2 can predict the occurrence and death of ARDS,and can also be used to evaluate the severity of ARDSConclusions:1.The clinical indexes have good specificity in predicting the occurrence of ARDS.2.Joint prediction of serum biological markers can improve sensitivity and specificity in the early warning and prognostic analysis of ARDS.3.The indirect ARDS has more serious injury of pulmonary vascular endothelial cells than direct ARDS.