Analysis Of The Correlation Between ARDS And Its Prognostic Factor

Objective: To discuss the related indicators to prognose the acute respiratory distress syndrome (ARDS) .Method: analysis on 30 cases of ARDS patients admitted in the Department of Respiratory Intensive Care Unit (RICU) of the General Hospital of Shenyang Military Region by using gender, age, the basis of disease, induced factors (pulmonary and extra-pulmonary), with multiple organ dysfunction syndrome (MODS) , Time to disease diagnosis , APACHEⅡscore, the oxygenation index (PaO2/FiO2), C-reactive protein (CRP), serum albumin (ALB), blood urea nitrogen (BUN), invasive/ non-invasive mechanical ventilation and other factors. The analyzed single factor which is a significant variable is graded and assigned: including BUN (≥8.2 BUN = 1; <8.2 BUN = 0); CRP (increase = 1; decrease= 0); MODS (with= 1; without = 0); the duration between onset and diagnosed (≥7 days = 1; <7 days = 0); basis of disease (has = 1, has none = 0); induced factors (pulmonary = 1; extra-pulmonary = 0) , These relevant factors are then analyzed.Results:1.20 of 30 cases of ARDS patients died, 10 cases survived. There are no significant difference (P> 0.05) between the death group and survival group in CRP, APACHEⅡscore, PaO2/FiO2, ALB base value (when diagnosed) . The mortality significantly increased in patients with basal disease, MODS, long duration between disease onset and diagnosis, and abnormal BUN value when diagnosed. The mortality of ARDS patients significantly correlated with the basal disease in history (r = 0.55, P = 0.002), MODS (r = 0.62, P = 0.00), long duration of disease onset to the diagnosis (r = 0.43, P = 0.017), increased CRP level ( r = 0.866, P = 0.00),and pulmonary factor(r = 0.60, P = 0.003) .2.C-reactive protein (CRP): the CRP values after treatment are lower than before treatment, whereas in the death group, 3 cases decreased after treatment and 17 cases increased. There are significant difference in CRP level after treatment and when compared with CRP level before treatment and after treatment between the two groups (P <0.01). The mortality of patients with decreased CRP level after treatment (23.1% , 3 / 13) was significantly lower than the patients with elevated CRP level (100% ,17/17) (P <0.01).3.APACHEⅡscore:the differences of the score between the death group and the survival group in day 5 and day 7 days after treatment are very significant (P <0. 01). The differences are also significant when compared day 5, 7 with basal level and day 7 with day 3, 5 after treatment (P<0.05). The score in survival group of day 7 is significantly different to day 3 (P <0. 01). APACHEⅡscore in death group increased with the duration of hospitalization and on the contrary, the score in survival group lowered with the duration of hospitalization.4.PaO2/FiO2: The differences are very significant in day 3, 5, 7 between the death group and the survival group (P <0. 01). And there are also very significant differences compared with basal value on day 5 in the death group (P <0. 01), and no differences are found in the survival group.5.Serum albumin (ALB): the ALB level is significantly different between the death and survival group on day 5, 7 (P <0. 05). There are significant difference between the basal values and the values on day 7 in the survival group (P <0. 05). The differences are also significant between day 5, 7 and day 3 (P <0. 05). But there are no significant changes in the death group. The ALB level increases along with the duration of hospitalization.6.Blood urea nitrogen (BUN): Both in the death group and the survival group,the differences are significant between the basal value and that of day 5 , 7(P <0.05). In survival Group , the values of day 3 differ significantly with day 5, 7 (P <0.05), while no significant changes are found in the death group. There is no difference between the two groups when the basic value is in the normal range (P> 0.05), whereas there is significant difference between the two groups when the basal value is abnormal (P <0.05).Conclusion: the mortality significantly increased when there are basal diseases in history, MODS, long duration of onset to diagnosis, pulmonary disease and abnormal BUN value. The survival rate of patients with decreased CRP was significantly higher than patients with higher CRP value. Dynamic observation of CRP, APACHEⅡscore, PaO2/FiO2, ALB, Bun and other changes will help to predict the clinical prognosis and direct the treatment. In addition increased CRP after treatment, MODS, and pulmonary disease correlated highly with the mortality. Basal diseases and long duration of diagnosis also correlate with the mortality which can be used as indicators of the prognosis of the ARDS patients.