The Evaluation Value Of Lactate Clearance Rate And Thoracic Fluid Content In The Severity And Prognosis Of ARDS

Objective:To investigate the value of lactate clearance rate(LCR)and thoracic fluid content(TFC)in evaluating the severity and prognosis of patients with acute respiratory distress syndrome(ARDS).Whether TFC can improve the sensitivity,specificity and accuracy of predicting prognosis by comparing a single index,so as to bring certain guidance to the clinical treatment of ARDS patients.Methods:1.From January 1,2019 to June 30,2021,90 patients with ARDS admitted to the Intensive Care Unit of the Affiliated Hospital of North Sichuan Medical College were retrospectively analyzed,and their general information was recorded:(1)General information,including gender,Age,time from onset to diagnosis of ARDS,ICU stay,mechanical ventilation time,and main etiology;(2)Respiratory-related parameters:oxygenation index(OI),positive end expiratory pressure(PEEP)value(3)Acute Physiology and Chronic Health Score Ⅱ(APACHE Ⅱ)within 24 hours;(4)28-day prognosis(survival or not);(5)Inspection parameters after ARDS diagnosis:the maximum value on the day when ARDS was diagnosed Lactic acid(Lac)and Lac after 24 hours were calculated and LCR was calculated.Procalcitonin(PCT),white blood cell count(WBC)and TFC were determined on the day of diagnosis.2.Divide the patients into three subgroups of mild,moderate and severe according to the Berlin diagnostic criteria,analyze the general conditions of patients with different disease severity,and compare the differences between the groups.3.Spearman rank sum correlation analysis was used to evaluate the correlation between LCR,TFC and OI in ARDS patients.4.Taking patients diagnosed with ARDS as the starting point of the study,the patients were divided into survival group and death group according to the 28-day prognosis.The differences between the two groups were compared and the independent risk factors of ARDS patients’ 28-day death were analyzed by univariate and multivariate Logistic regression.5.Draw receiver operating characteristic curve(ROC),and analyze the predictive value of LCR and TFC on the prognosis of ARDS patients.Results:A total of 90 ARDS patients were enrolled,including 59 males and 31 females,with an average age of 61(52,72.25)years;20 patients with mild ARDS,45 patients with moderate ARDS,and 25 patients with severe ARDS;19 patients survived within 28 days.71 cases died.Compared with the mild ARDS group,the severe group had higher APACHE Ⅱ score,higher PEEP,higher Lac,lower LCR,higher TFC,and higher 28-day mortality rate,and the differences were statistically significant(P<0.05).Compared with the ARDS group,the severe group had higher APACHE Ⅱ score,higher PEEP,higher Lac,and higher 28-day mortality rate,and the differences were statistically significant(P<0.05).Compared with the mild ARDS group,the moderate group had higher TFC,and the difference was statistically significant(P<0.05).Spearman rank sum correlation analysis showed that there was a correlation between LCR,TFC and OI in ARDS patients,the correlation coefficient r values were 0.302 and-0.545,respectively,and the differences were statistically significant(P<0.05).Compared with the survival group,the death group had a shorter ICU stay,higher APACHE Ⅱ score,lower OI,higher Lac,lower LCR and higher TFC(P<0.05).Logistic regression analysis showed that ICU length of stay,APACHE Ⅱ score,LCR and TFC were independent risk factors for 28-day death in ARDS patients(P<0.05).The ROC curve analysis of this study showed that:(1)LCR(AUC=0.703,95%CI=0.571～0.835,sensitivity was 73.2%,specificity was 47.4%,best cut-off value was 38.97%,P=0.003);(3)TFC(AUC=0.774,95%CI=0.675～0.873,the sensitivity was 63.4%,the specificity was 89.5%,the best cut-off value was 30,P=0.000);(4)The combination of LCR and TFC(AUC=0.825,95%CI=0.733～0.916,sensitivity was 84.5%,specificity was 89.5%,P=0.000).Conclusion:1.LCR and TFC are closely related to the severity and prognosis of ARDS.2.LCR and TFC were independent risk factors for ARDS patients’28-day death.3.Both LCR and TFC may be used to predict the prognosis of ARDS patients,and the accuracy of LCR combined with TFC in predicting the prognosis of ARDS patients is better than univariate,and the combined diagnostic value is higher.