Association of immune deficiency with prognosis and corticosteroids treatment benefits among patients with ARDS

Abstract

Abstract Objective To investigate the prognostic significance of immune deficiency in ARDS and its response to different doses of corticosteroids. Methods The study enrolled 657 patients and they were divided into discovery dataset (n = 357) and validation dataset (n = 300) according to the time of admission, and the relationship between immune deficiency and prognosis and response to corticosteroid therapy in patients with different severity were also analyzed. Results Immune deficiency was an independent prognostic factor affecting overall survival. Analysis showed that patients with mild to moderate ARDS (Discovery dataset: HR 1.719; 95% CI 1.229–2.406; Validation dataset: HR 1.874; 95% CI 1.238–2.837) or severe ARDS (Discovery dataset: HR 1.874; 95% CI 1.007–3.488; Validation dataset: HR 1.698; 95% CI 1.042–2.768) with immune deficiency had lower overall survival. And mild to moderate ARDS with immune deficiency benefit better from low dose corticosteroids (HR 0.409; 95% CI 0.249–0.671), severe ARDS with immune deficiency benefit better from both low (HR 0.299; 95% CI 0.136–0.654) and high dose corticosteroid treatment (HR 0.458; 95% CI 0.214–0.981). Conclusions Immune deficiency was considered to be an independent risk factor in ARDS patients, and its inclusion in the disease severity grading system based on PaO2/FiO2 was conducive to promoting personalized medication for ARDS patients.