Earlysepsis With ARDS Patients EVLWI,Ang2,vWF And New Berlin Grading And Prognosis Evaluation

Objective To evaluate the correlation between extravascular lung water index(EVLWI) combining with Ang-2, v WF factor, and severity of early sepsis with acute respiratory distress syndrome(ARDS) patients which is guided by the standard grade of Berlin criteria. To explore its applied value for assessing the severity and prognosis of diseases.Method A retrospective analysis of clinical data of 41 early septic and ARDS patients adimitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from January 2013 to June 2014, who were monitored by Pi CCO. And they were divided into three groups, mild group, moderate group and severe group, according to the oxygenation index(Pa O2/Fi O2) at the beginning of ICU admission. The endpoint of observation was the outcome on the 28 thday, according which these patients were divided into two groups, survival group and death group. Pi CCO was used to measure the level of EVLWI at the beginning, 1st,2nd and 3rd day of ICU admission. The level of Ang-2 and v WF were measured by enzyme-linked immunosorbent assay(ELISA).At the same time, general information at baseline,duration of mechanical ventilation and the length of ICU stay of these patients were recorded. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and Sequential Organ Failure score(SOFA) were calculated. The difference of EVLWI, Ang-2 and v WF between the survival group and the death group were compared respectively. Corralation analysis between these index and the oxygenation index was performed, receiver operating characteristic curve(ROC) was drawn and the prognostic value of each parameter was assessed.Results A total of 41 early septic and ARDS patients were enrolled, with 22 cases in the survival group and 19 cases in the death group. The APACHE Ⅱ, EVLWI and Ang-2 in the death group were significantly higher than those of the survival group at ICU admission(all P<0.01),and the length of ICU stay was significantly shorter than that of the survival group, while differences of the other clinical characteristics at baseline between two groups were not statistically significant(P>0.05). EVLWI gradually declined in survival group, but increased in death group. The level of EVLWI at the beginning, 1st,2nd and 3rd day of ICU admission in death group were significantly higher than those in survival group[EVLWI(ml/kg) 0d: 13.67 ± 6.16 vs 9.82 ± 2.81, t = 3.324, P = 0.038; 1 d: 14.05 ± 6.29 vs 9.13 ± 2.70, t = 3.732, P = 0.032; 2 d: 14.58 ± 6.89 vs 8.82 ± 2.40, t = 4.738, P = 0.001; 3 d: 15.32 ± 6.71 vs 7.50 ± 1.95, t = 5.225, P = 0.000]. The levels of plasma Ang-2 of both group rose first and then decreased. Its level at the beginning, 1st,2nd and 3rd day of ICU admission in death group were significantly higher than the survival group [Ang-2(ng/L) 0 d: 402.41±227.54 vs 259.47±153.52, t=4.879, P=0.000; 1 d: 409.36±212.31 vs 279.22±140.83, t=4.138, P = 0.014; 2 d: 439.72±207.56 vs 318.76±168.65, t = 3.327, P = 0.038; 3 d: 425.66±204.89 vs 302.94±167.04, t=3.979, P=0.022].The levels of plasma v WF of both groups rose gradually. Its level at the beginning, 1st,2nd and 3rd day of ICU admission in death group were higher than the survival group, but there was no statistically significant differences between the two groups. [v WF(U / L) 0 d: 615.72 ± 603.14 vs 527.75 ± 576.59, t = 0.807, P = 0.543; 1 d: 602.53 ± 553.20 vs 515.04 ± 689.15, t = 0.789, P = 0.625; 2 d: 799.06 ± 842.15 vs 718.31 ± 762.67, t = 0.837, P =0.492; 3 d: 841.62 ± 782.93 vs 806.95 ± 610.49, t = 0.911, P = 0.461].At the beginning of ICU admission, all of these index were not correlated(all P> 0.05). At the 1st,2nd and 3rd day of ICU admission, Ang-2 was significantly positively correlated with EVLWI(r1 = 0.605, r2 = 0.458, r3 = 0.392,1,2d: P <0.01,3d: P <0.05). At the1 st 、2ndday and3 rd of ICU admission, it showed a negative correlation between Ang-2 and Pa O2/Fi O2(r1 =-0.656, r2 =-0.429,r3=-0.354,1,2d: P <0.01,3d: P <0.05), and between EVLWI and Pa O2/Fi O2(r1 =-0.739, r2 =-0.473, r3=-0.388,all P <0.01). At the 1st,2nd and 3rd day of ICU admission, v WF and Pa O2/Fi O2 had no significant correlation(r1 =-0.107, r2 = 0.075, r3 = 0.345, all P> 0.05). ROC curve analysis showed that the area under the ROC curve(AUC) of Ang-2 at the 1st day of ICU admission was 0.778 ± 0.075.at acut-off point of 315.15 ng / L, and the sensitivity of prognostic value was 84.21%, the specificity 68.18%; At the 3rd day of ICU admission, the AUC of EVLWI was 0.818 ± 0.068, at a cut-off value of 12.5 m L/kg, which showed a sensitivity of 63.16%, and a specificity of 95.45%; Both of the prognostic value are better than APACHEⅡ, SOFA score at the same point. At the 1st day, the AUC of Ang-2 combining with EVLWI was 0.844 ± 0.064, at a cutoff value of 0.483, a sensitivity of 88.42% and a specificity of 90.91%; at the 3rd day the AUC of Ang-2 combining with EVLWI was 0.828 ± 0.066, at a cutoff value of 0.646, a sensitivity of 84.65%, and a specificity of 95.45%, which showed that the combination of Ang-2 and EVLWI had a better assessment value than each of alone.(all P <0.01).Conclusion Ang-2 can act as a useful serological index for early sepsis with ARDS and shows a negative correlation with Berlin grading, which is identical with EVLWI. But there is no correlation between factor v WF and Berlin grading. Thus, the combination of Ang-2 and EVLWI can provide guidance for early assessment of septic patients with ARDS’ severity and prognosis, also including positive intervention and treatment for high-risk patients.