Correlation Of Inflammatory Indicators With Severity And Outcome Of Acute Respiratory Distress Syndrome In Newborns

Objective:The purpose of this study was to retrospectively analyze the relationship between maternal factors,perinatal factors and general clinical tests in relation to disease severity and prognosis of ARDS in children diagnosed with neonatal acute respiratory distress syndrome(ARDS)at the Affiliated Hospital of Yangzhou University,and to provide reference for the diagnosis,disease assessment and prognosis of clinical neonatal ARDS.Methods:This study retrospectively analyzed a total of 55 children with ARDS who were transferred to our NICU within 24 hours of birth and met the inclusion and exclusion criteria of the study from 01 2018 to 06 2022 at the Affiliated Hospital of Yangzhou University,and collected general clinical information on the children through the hospital information system,including their gender,gestational age,mode of birth,Apgar score,admission day age,admission weight,admission respiratory The information included gender,gestational age,birth mode,Apgar score,admission age,admission weight,admission respiratory frequency,age at admission,basic maternal conditions(glucocorticoid use,allergic rhinitis and atopic asthma and other eosinophilic disorders,gestational hypertension,premature rupture of membranes),length of ventilator use,nitric oxide(NO)and pulmonary surface active substance(PS)use,etc.;laboratory parameters within 24 hours of admission,such as EOS,NEU,lymphocyte(LYM),neutrophil-to-lymphocyte ratio(NLR),PCT,hs-CRP,and lactate(Lac)within 24 hours of admission.The neonatal ARDS patients were divided into 26 cases in the mild ARDS group(4.0≤OI<8.0),13 cases in the moderate ARDS group(8.0≤OI<16.0),and 16 cases in the severe ARDS group(OI≥16.0)according to their oxygenation index(OI);34 cases in the good outcome group and 21 cases in the poor outcome group according to their outcome(death,transfer,abandonment,or invasive≥10 days).The differences in the general clinical correlation indexes of the children in each group were compared by univariate analysis,and the relationship between each index and the severity and prognosis of ARDS patients was evaluated by multifactorial analysis performed by binary logistic regression model,and ROC curves were drawn to analyze the predictive value of EOS,NEU,NLR,PCT and hs-CRP on the severity and outcome of ARDS patients.Results:1.Correlation between general clinical related indexes and the severity of ARDS patients(1)A total of 55 patients were included in this study,including 26 cases in the mild ARDS group,13 cases in the moderate ARDS group,and 16 cases in the severe ARDS group.There was a statistically significant difference between the admission respiratory rate in the mild and moderate groups(P<0.05),and the history of premature rupture of the mother’s membranes in the severe group was statistically different from that in the mild and moderate groups,respectively(P<0.05).(2)The differences in peripheral blood NEU,serum PCT and hs-CRP levels were statistically significant(P<0.05)when comparing the children with ARDS in the mild,moderate and severe groups,in which the blood NEU and serum PCT levels in the severe group were higher than those in the mild and moderate groups(P<0.05),and the hs-CRP level in the severe group was higher than that in the mild group(P<0.05),but the hs-CRP in the moderate and severe group was not statistically significant(P>0.05).(3)Multi-factor logistic regression analysis showed that NEU,hs-CRP and PCT were independent risk factors affecting the severity of neonatal ARDS,with OR values of 1.330,1.057 and 1.064,respectively(P<0.05).(4)By plotting the ROC curves,the AUCs of NEU,PCT and combined prediction of ARDS severity were 0.856,0.808 and 0.933,with sensitivities of 93.8%,75.0%and 93.8%,and specificities of 82.1%,79.5%and 89.7%,respectively.The combined prediction had better ability to predict the severity of ARDS patients compared with hs-CRP and PCT alone,respectively(P<0.05).2.Correlation between general clinically relevant indicators and the outcome profile of ARDS patients(1)A total of 55 patients were included in this study,including 34 cases in the good outcome group and 21 cases in the poor outcome group.There was no statistically significant difference between the baseline information of the children with ARDS with different outcomes,such as general condition,maternal disease condition,and perinatal condition(P>0.05).(2)When comparing the peripheral blood EOS,NEU,NLR,and serum PCT levels of children in the good outcome group with those in the poor outcome group,the differences were statistically significant(P<0.05),and the peripheral blood NEU,NLR,and serum PCT levels of children in the poor outcome group were higher than those in the good group,and the EOS levels were lower than those in the good group(P<0.05).(3)A multifactorial binary logistic regression analysis showed that peripheral blood NEU and PCT values were independent risk factors for poor neonatal ARDS outcome with ORs of 1.655 and 1.12,respectively(P<0.05),and peripheral blood EOS values were protective factors for poor neonatal ARDS outcome with an OR of 0.122(P<0.05).(4)By plotting the ROC curves,it was shown that the AUCs of EOS,NEU,PCT and the combination of the three for predicting poor ARDS outcome were 0.183,0.877,0.835 and 0.951,respectively,with sensitivities of 14.3%,85.7%,76.2%and 99.9%and specificities of 30.4%,88.2%,88.2%and 99.9%,respectively,in the poor outcome group compared with the good outcome group,88.2%,88.2%and 76.5%,respectively.The combined prediction had better ability to predict the outcome of ARDS patients compared with EOS and PCT alone,respectively(P<0.05).Conclusions:(1)NEU,PCT and hs-CRP are independent risk factors for the severity of ARDS in newborns;(2)NEU and PCT can be used as predictors of neonatal ARDS severity,and their combination is more effective in predicting ARDS severity.(3)NEU and PCT are independent risk factors for poor neonatal ARDS outcome,while EOS are protective factors for poor outcome;(4)EOS,NEU and PCT can be used as predictors of neonatal ARDS outcome,and the combination of these three predictors is more effective in predicting ARDS outcome.