Single center cross-sectional survey and prognostic risk factors analysis of sepsis complicated with ARDS based on “Berlin definition”

Abstract

Abstract Objective:To investigate the prognostic risk factors for sepsis complicated with acute respiratory distress syndrome (ARDS) based on the Berlin definition. Methods: A total of 152 patients with sepsis complicated with ARDS admitted to the intensive care unit of our hospital from June 2016 to August 2017 were enrolled. According to the in-hospital clinical outcome, they were divided into death group (n=113) and survival group (n=39). The general characteristics, medical history, treatment and blood biochemical indexes of the two groups were collected. Multivariate Logistic regression analysis was performed to analyze the risk factors of death in these patients. The nomogram prediction model of inpatient death was constructed, and the prediction value of this model was assessed by receiver operating characteristic (ROC) curve. Results: There were obvious differences in the survival group and death group with regard to total hospital stay, APACHE II score, ARDS lung infection, concurrent diseases, fluid accumulation unbalance within 72 hours of admission, type of sepsis, number of organ failure, tracheotomy, blood purification, and coagulation dysfunction (P< 0.05). Prominent differences were examined in the levels of laboratory indexes of albumin and urea between the two groups (P < 0.05). Logistic regression analysis demonstrated that APACHE II score, ARDS pulmonary infection, unbalance of fluid accumulation 72 hours after admission, organ failure number and coagulation dysfunction were independent risk factors for death in sepsis patients with ARDS, and blood purification was protective factor (P < 0.05). The findings of ROC curve illustrated that the area under the curve of the nomogram for forecasting in-hospital death in patients with sepsis and ARDS was 0.822 (95% CI 0.712-0.899), with a sensitivity of 80.25% and a specificity of 75.26%. Conclusion: The prognosis of sepsis ARDS is poor and the mortality rate is extremely high. Active prevention should be taken to improve the cure rate of ARDS. Early use of blood purification and other rescue measures can help reduce the mortality rate of patients with sepsis complicated by ARDS.