The Prognostic Factors Of Severe Acute Pancreatitis Complicated With Acute Respiratory Distress Syndrome

Objective: To investigate the prognostic factors of severe acute pancreatitis complicated with acute respiratory distress syndrome in Intensive care unit(ICU).Methods and materials: Retrospective study was performed among 78 patients with the diagnosis of SAP in Intensive care unit(ICU)and emergency department of Intensive care unit(EICU)of The First Affiliated Hospital of Dalian Medical University from January 2010 to August 2015.The patients were divided into two groups,ARDS group and non-ARDS group,according to whether complicated with ARDS.Then the patients in ARDS group and non-ARDS group were respectively divided into two subgroups according to the clinical outcome: survival group and death group.The general characteristics and the different prognosis were compared in patients in ARDS group and non-ARDS group,then carried on the multivariate regression analysis with the statistical significance.To investigate the prognostic factors of SAP complicated with ARDS.Results: A total of 78 patients with SAP,including 56 cases accounted for 71.80% of male and 22 females accounted for 28.20%.42 patients(53.8%)complicated with ARDS,36 patients without ARDS(46.15%).Death occurred in ARDS group was 32(32/42,76.20%),while in non-ARDS was 18(18/36,50.00%).Single factor analysis found that the majority of ARDS group were male and alcoholism,PO2/Fi O2 and albumin were lower than those in non-ARDS group,Age,blood glucose,APACHE? score,SOFA score,BISAP score,MCTSI score and mortality rates were higher than non-ARDS group and there were statistically significant differences(P<0.05 or P<0.01).Although the SCr,TBil,PCT in ARDS group were all higher than those in non-ARDS group,but there were no significant statistical differences(P>0.05).Multivariate binary logistic analysis showed that the low serum albumin(OR=6.344,95%CI=3.475~9.266,P = 0.007),elderly(OR=2.694,95%CI=1.119~11.355,P = 0.003),history of alcohol abuse(OR=1.675,95%CI=1.255~7.977,P = 0.012),APACHE?score(OR=1.976,95%CI=1.855~917.5,P = 0.025)and BISAP score(OR=2.155,95%CI=1.716~10.475,P = 0.037)were the independent risk factors of occurred acute respiratory distress syndrome(ARDS).Single factor analysis on the prognosis of the patients with SAP and ARDS showed that,the albumin and oxygen index in death group lower than the those in survival group,and age,APACHE? score,BISAP score in death group all higher than the survival group,the days of hospitalization in ICU in death group lower than the those in survival group and there were statistical significance(P< 0.05).Multivariate logistic analysis showed that albumin(OR=4.068,95%CI=3.138~11.073,P = 0.023),oxygen synthetic index(OR=2.168,95%CI=1.398~5.433,P = 0.039),APACHE? score(OR = 8.066,95%CI=2.388~15.273,P = 0.001)was independent adverse prognostic risk factors of occurred SAP with ARDS.Single factor analysis of SAP patients with non ARDS showed that,the age,TBil,APACHE? score,MCTSI score in the death group higher than those in survival group,and there were statistical significance(P<0.05 or P< 0.001).Then multivariate logistic analysis showed that the APACHE ? score(OR = 1.215,95% CI = 1.008~1.463,P = 0.041),age(OR= 1.108,95% CI = 1.014~2.210,P = 0.023)were independent adverse prognostic risk factors of occurred SAP without ARDS.Conclusions:1.The age,the history of alcohol abuse,low serum albumin,the higher of APACHE? score and BISAP score in patients with SAP were the risk factors for occurred ARDS.2.Albumin,oxygenation index,APACHE? score were the risk factors for the poor prognosis in patients SAP complicated with ARDS,maybe early clinical prediction for ARDS and early intervention to provide a reference.3.Advanced age and high APACHE? score were the risk factors for poor prognosis of SAP without ARDS.