Prognosis and related risk factors of acute respiratory distress syndrome in elder patients
Huang Xu, Wu Dawei, Lu Haining, Wang Daoxin, Deng Wang, Sun Tongwen, Xing Lihua, Liu Shaohua, Wang Shilei, Luo Hong, Zhang Han, Liu Jialin, Tan Ruoming, Yang Jingping, Xu Xiyuan, Wu Rina, Yan Xixin, Xu Haibo, Xu Sicheng, Luo Xia, Zhao Beilei, Pan Binhai, Teng Hong, Chen Lijuan, Tian Ye, Cai Ying, Zhan Qingyuan
Abstract
ObjectiveTo study the risk factors associated with the hospital survival rate of elder patients with acute respiratory distress syndrome (ARDS) in Medical/Respiratory Intensive Care Units (MICUs/RICUs) by evaluating the prognosis, and therefore to provide insight into patient treatment strategy.
MethodsTwenty MICUs/RICUs of 19 general hospitals in mainland China participated in the multicenter prospective cohort study carried out from Mar 1st, 2016 to Feb 28th, 2018. Patients who met the criteria of Berlin ARDS and older than 65 years were recruited. Baseline data, risk factors of ARDS, ventilator setup and prognosis data were collected from all patients. Univariant and multivariant regression analysis were conducted to analyze the factors associated with the prognosis.
Results170 elder ARDS patients (age≥65 years) met the Berlin ARDS criteria, among whom 8.8% (15/170), 42.9% (73/170) and 48.2% (82/170) patients had mild, moderate and severe ARDS, respectively. The most common predisposing factor for elder ARDS was pneumonia, which was present in 134 patients (78.8%). 37.6% (64/170) patients were treated with noninvasive mechanical ventilation (NIV), but 43.8% (28/64) cases experienced treatment failure. 76.5% (130/170) patients were treated with invasive mechanical ventilation. All patients 80 years or older were given invasive mechanical ventilation. 51.8% (88/170) cases had complications of non-pulmonary organ failure. 61.8% (105/170) patients deceased during hospital stay. Multivariant logistic analysis showed that the independent risk factors for hospital survival rate in elder patients with ARDS were SOFA score (P=0.030, RR=0.725, 95% CI 0.543-0.969), oxygen index after 24 hours of ARDS diagnosis (P=0.030, RR=0.196, 95% CI 0.045-0.853), accumulated fluid balance within 7 days after diagnosis of ARDS (P=0.026, RR=1.000, 95% CI 1.000-1.000) and shock (P=0.034, RR=0.140, 95% CI 0.023-0.863).
ConclusionAmong 20 ICUs, the high mortality rate of elder patients with ARDS was correlated with higher 24 hour SOFA score, lower 24 hour oxygen index after ARDS diagnosis, more positive fluid balance within 7 days and concomitant shock. The conservative fluid strategy within 7 days of ARDS diagnosis may benefit the elder ARDS patients.
Key words:
Respiratory distress syndrome,adult; Epidemiology; Aged; Prognosis
Contributor Information
Huang Xu
Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases,National Center for Respiratory Medicine, Beijing 100029,China
Wu Dawei
Department of Critical Care Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao 266035, China
Lu Haining
Department of Critical Care Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao 266035, China
Wang Daoxin
Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Deng Wang
Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Sun Tongwen
Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhqngzhou 450052, China
Xing Lihua
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhqngzhou 450052, China
Liu Shaohua
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhqngzhou 450052, China
Wang Shilei
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhqngzhou 450052, China
Luo Hong
Respiratory Department, the second Xiangya hospital of Central South University, Changsha 410011, China
Zhang Han
Respiratory Department, the second Xiangya hospital of Central South University, Changsha 410011, China
Liu Jialin
Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Tan Ruoming
Department of Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200001, China
Yang Jingping
Department of Respiratory and Critical Care Medicine, Inner Mongolia Baogang Hospital, Baotou 014016, China
Xu Xiyuan
Department of Respiratory and Critical Care Medicine, Inner Mongolia Baogang Hospital, Baotou 014016, China
Wu Rina
Department of Respiratory and Critical Care Medicine, Inner Mongolia Baogang Hospital, Baotou 014016, China
Yan Xixin
Department of Respiratory and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050052, China
Xu Haibo
Department of Respiratory and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang 050052, China
Xu Sicheng
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, Wulumuqi 830054, China
Luo Xia
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Xinjiang Medical University, Wulumuqi 830054, China
Zhao Beilei
Department of Respiratory and Critical Care Medicine, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, China
Pan Binhai
Department of Respiratory and Critical Care Medicine, Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, China
Teng Hong
Department of Respiratory and Critical Care Medicine, Sichuan Provincial People′s Hospital, Chengdu 610072,China
Chen Lijuan
Department of Respiratory and Critical Care Medicine, Sichuan Provincial People′s Hospital, Chengdu 610072,China
Tian Ye
Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases,National Center for Respiratory Medicine, Beijing 100029,China
Cai Ying
Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases,National Center for Respiratory Medicine, Beijing 100029,China
Zhan Qingyuan
Center for Respiratory Diseases, China-Japan Friendship Hospital, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases,National Center for Respiratory Medicine, Beijing 100029,China
