A Study On Prognosis Of ARDS Caused By Severe Pneumonia By Thrombelastogram

Objective:To investigate the predictive value of thrombelastogram indexes in evaluating the prognosis of patients with acute respiratory distress syndrome caused by severe pneumonia.Method:The cases were selected as the research objects in historic al cohort study,which from a third-class A hospital in Guangxi from Dec ember 2021 to December 2022.Patients who were diagnosed with severe pneumonia and ARDS and met other inclusion criteria were selected and further screened according to the exclusion criteria.According to the resul ts of thrombelastogram（CI）at the time of enrollment,the patients were d ivided into hypercoagulability group,normal group and hypocoagulability group.The patients were followed up for 28 days and the end-point even ts were recorded.The follow-up method was telephone follow-up,and all data were consulted in the medical record system of our hospital.The lo ss of follow-up was recorded.According to clinical outcome,the patients were divided into survival group and death group.The differences of con ventional coagulation function,thrombelastogram and other indicators in di fferent groups of patients with different prognosis were compared.Pearson correlation analysis was used to analyze the correlation between the thro mbelastogram,conventional coagulation function index and other major in dicators.COX regression equation and kaplan-meier survival curve were u sed to analyze the independent risk factors affecting the prognosis and sur vival time of ARDS patients with severe pneumonia.ROC curves were dr awn for independent predictors,and the predictive value of each indicator was analyzed to evaluate the prognosis of patients.Subgroups of include d patients were analyzed using the same statistical method to further dem onstrate the predictive value of TEG in assessing patient outcomesResult:（1）All patients were followed up for 28 days without loss o f follow-up.The clinical outcome of all patients was clear,and the 28-da y fatality rate was 53.85%.The hypercoagulability group accounted for a higher proportion of the total number of deaths,>70%.（2）Among patie nts with different prognosis,R,K,MA,P/F,AB,Pa O₂and Sa O₂in the death group were lower than those in the survival group;α,CI,APTT,P T,DD and Pa CO₂were higher than those in survival group.There were significant differences（P<0.05）.（3）R and K were positively correlated with APACHE II score,APTT,PT and DD,while MA was negatively co rrelated with APACHE II score,APTT,PT and DD（P<0.05）.（4）APAC HE II score,TEG（R,K,MA,CI）and DD can all be used as predictors of poor prognosis of ARDS patients with severe pneumonia,with signifi cant differences（P<0.05）,in which MA was the protective factor.The s urvival curve results showed that different coagulant states affected the su rvival time of ARDS patients with severe pneumonia（P<0.05）.The hype rcoagulability group had the median survival time was significantly lower than other groups.In the severe COVID-19 pneumonia induced ARDS su bgroup,the mortality rate was higher and the median survival time was l ower in the hypercoagulable group,while there was no significant differen ce in the severe non-COVID-19 pneumonia induced ARDS subgroup（P>0.05）.（5）ROC curve found that APACHE II score,DD and CI were all u seful（P<0.05）,in which,the area under the curve of CI was the largest i n single application,which was 0.819,and the highest in Yoden index w as 0.701.Combined application of APACHE II score showed that the AU C of CI+APACHE II score was 0.848 and the Yoden index was 0.744.I n the subgroup,the area under the curve of CI of ARDS patients with se vere COVID-19 was the largest,which was 0.838,and the highest Yoden index was 0.779.The AUC of CI+APACHE II score was 0.877 and th e Yoden index was 0.797,which showed higher predictive value.Conclusions:1.The thrombelastogram is a good indicator to evaluate the prognosis of ARDS patients caused by severe pneumonia,especially for ARDS patients caused by severe COVID-19 pneumonia,and has certa in clinical application value.The combined application of APACHE II sco re can further improve the prediction efficiency.2.When the CI in the th rombelastogram is greater than 3,the higher the CI value is,the more se rious the hypercoagulation state is,the lower the survival rate and the sh orter the survival time of the patients.