Prognostic factors for ARDS: clinical, physiological and atypical immunodeficiency

Abstract

Background: Risk factors affecting the prognosis of acute respiratory distress syndrome (ARDS) in adults were investigated. The aim was to identify new predictors for ARDS patient prognosis, including those with clinical, pathophysiological, and atypical immunodeficiency. Methods: ARDS patients were retrospectively included. The patients were grouped and analysed according to different oxygenation index grades and prognosis, and factors influencing prognosis and survival were examined. Adolescent patients, patients with typical immunodeficiency and patients who died within 24 h after being diagnosed with ARDS were excluded. The predictive value for mortality was determined by Cox proportional hazard analysis. Results: In total, 201 patients who fulfilled the Berlin definition of ARDS were included. The severity of critical illness on the day of enrolment, as measured by the Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.016), Sequential Organ Failure Assessment (SOFA) score (P = 0.027), and PaO 2 /FiO 2 (P = 0.000), worsened from mild to severe ARDS cases. Compared with survivors, non-survivors were significantly older and had higher APACHE II and SOFA scores. Moreover, significantly lower lymphocyte/neutrophil ratios and leukocyte counts were found among non-survivors than survivors (P = 0.008, P = 0.012). A moderate positive correlation between the lymphocyte/ neutrophil and PaO 2 /FiO 2 ratios (P = 0.023) was observed. In predicting 100-day survival in patients with ARDS, the area under the curve (AUC) for the lymphocyte/neutrophil ratio was significantly higher than those for the PaO 2 / FiO 2 ratio alone, body mass index (BMI) alone, and the lymphocyte count alone (P = 0.0062, 0.0001, and 0.0154). Age (per log 10 years), BMI < 24, SOFA score, leukocyte count, and the lymphocyte/neutrophil ratio were independent predictors of 28-day mortality in ARDS patients. Additionally, ARDS patients with a lymphocyte/ neutrophil ratio < 0.0537 had increased 28-day mortality rates (P = 0.0283). Old age affected both 28-day and 100day mortality rates (P = 0.0064,0.0057).

Coagulation Studies Are Not Predictive of Hematological Complications of COVID-19 Infection

“…Univariate analysis showed that patients with worse measures of disease severity including SOFA, P/F ratio, or requirement of IMV support, and days on MV had significantly worse mortality, which are known prognostic factors for worse outcomes in ARDS. 37 38 Finally a low ADAMTS13 level was associated with higher mortality in our study. Previous investigations have implicated ADAMTS13 levels as a marker for elevated risk of thrombosis and mortality.…”

Increased neutrophil-to-lymphocyte ratio predicts the development of post-stroke infections in patients with acute ischemic stroke

“…A large number of Fig. 1 Receiver operating characteristic curve analysis for NLR for prognostic value for PSI studies have shown that higher NLR might be an independent predictor of clinical outcome in a variety of diseases, including malignant tumors, acute respiratory distress syndrome, fibrotic liver disease and cardiovascular diseases [29][30][31][32]. At present, it has been paid more attention in the research of neurovascular diseases [33][34][35].…”

Aspirin Attenuates Hyperoxia-Induced Acute Respiratory Distress Syndrome (ARDS) by Suppressing Pulmonary Inflammation via the NF-κB Signaling Pathway

“…In addition, after hyperoxia, lungs exhibited pulmonary edema, alveolar infiltration, a greater number of macrophages, and a lower number of lymphocytes compared with the negative control group. Song et al (Song et al, 2020) also indicated that as ARDS severity increases, lymphocyte counts decrease. However, the groups posttreated with 25 or 50 μg/g aspirin exhibited less pulmonary edema and alveolar infiltration, a lower number of macrophages, and a greater number of lymphocytes than the group exposed to hyperoxia alone.…”