| Objective: To explore the clinical value of red blood cell distribution width to albumin ratio(RAR)in sepsis complicated with acute respiratory distress syndrome(ARDS).In order to find a new idea of diagnos is and treatment of sepsis complicated with ARDS.Methods: According to the inclusion and exclusion criteria,159 patients with sepsis who were admitte d to the comprehensive ICU of the First Affiliated Hospital of Henan University from January 1,2017 to D ecember 31,2022 are collected in this study.Their general data(gender,age,BMI and basic diseases,etc.)and the first clinical data(blood routine,blood biochemistry,blood gas analysis,procalcitonin,C-reactive protein,APACHE Ⅱ score,SOFA score,etc.)were recorded.The patients included in the study will be clas sified according to whether they have ARDS when they are admitted to ICU.They were divided into sepsis with ARDS group(ARDS group)and sepsis without ARDS group(No-ARDS group),and then the patients in sepsis with ARDS group were divided into survival group and death group according to their 28-day sur vival.The clinical data differences between ARDS group and No-ARDS group,survival group and death gr oup were compared,and the independent risk factors of sepsis complicated with ARDS and its prognosis w ere identified by univariate and multivariate analysis.Receiver operating characteristic curve(ROC)was us ed to analyze the clinical application value of RAR,APACHE Ⅱ score,SOFA score,CRP and PCT in patie nts with sepsis complicated with ARDS.Results:First part:a total of 159 adult sepsis patients were included,including 97 patients with ARDS(ARDS group)and 62 patients without ARDS(No-ARDS group).The analysis between the two groups showed that:In the analysis between basic data sets,The gender(male),age,BMI,days of mechanical ventilation,days of hospitalization in ICU and basic diseases(hypertension,diabetes,coronary heart disease)in ARDS group were compared with those in No-ARDS group,the difference was not statistically significant(P>0.05).In the inter-group analysis of laboratory indexes and disease score data,APACHEⅡscore,SOFA score,RAR,RDW,CRP,PCT and Lac in ARDS group were significantly higher than those in No-ARDS group,while ALB was significantly lower than that in No-ARDS group,with statistical significance(P<0.05).Univariate and multivariate logistic regression analysis showed that:RAR(P<0.001,OR=13.494,95%CI:5.371～33.905),APACHEⅡscore(P<0.001,OR=1.207,95%CI:1.104～1.319),SOFA score(P=0.008,OR=1.336,95%CI:1.078～1.657)are independent risk factors for sepsis complicated with ARDS.The ROC curve was drawn to evaluate the predictive value of RAR,APACHEⅡscore,SOFA score,RDW and ALB in sepsis complicated with ARDS.The results showed that the area under the RAR curve was 0.887,the sensitivity was 87.6%,the specificity was 75.8%,and the optimal threshold was 4.70.The area under the APACHE II scoring curve is 0.768,the sensitivity is 52.6%,the specificity is 93.5%,and the optimal threshold is 23.5.The area under the SOFA score curve is 0.698,the sensitivity is 47.4%,the specificity is 85.5%,and the optimal threshold is 7.5.The area under the RDW curve is 0.834,the sensitivity is 73.2%,the specificity is 79.0%,and the optimal threshold is 13.70.The area under the ALB curve is 0.833,the sensitivity is 74.2%,the specificity is 75.8%,and the optimal threshold is 2.72.According to the optimal threshold of the ROC curve,RAR≥4.70%/g/d L is defined as high RAR group,and RAR<4.70%/g/dl is defined as low RAR group.By multivariate logistic regression analysis,high RAR(P<0.001,OR=20.877,95%CI:7.818～55.754)is an independent risk factor for sepsis complicated with ARDS.The second part:97 cases of sepsis complicated with ARDS were divided into a survival group(40 cases)and a death group(57 cases)according to the 28-day survival situation.The analysis between the two groups showed that:In the analysis between basic data sets,the gender(male),BMI,ICU hospitalization time and basic diseases(hypertension,diabetes,coronary heart disease)in the death group were compared with those in survival group,the difference was not statistically significant(P>0.05).In the inter-group analysis of laboratory indexes and disease score data,APACHEⅡscore,SOFA score,RAR,RDW,CRP,PCT and Lac in death group were significantly higher than those in survival group,while ALB was significantly lower than that in survival group,with statistical significance(P<0.05).Univariate and multivariate logistic regression analysis showed that RAR(P=0.001,OR=6.542,95%CI:2.060～20.777),APACHEⅡ评分(P=0.04,OR=1.145,95%CI:1.006～1.303)和SOFA评分(P=0.002,OR=2.115,95%CI:1.319～3.391)are independent risk factors for death of sepsis complicated with ARDS.The ROC curve was drawn to evaluate the prognostic value of RAR,APACHEⅡscore,SOFA score,RDW and ALB in sepsis complicated with ARDS.The results showed that the area under the RAR curve was 0.770,the sensitivity was 86%,the specificity was 62.5%,and the optimal threshold was5.34.The area under the APACHE II score curve is 0.771,the sensitivity is 61.4%,the specificity is 87.5%,and the optimal threshold is 25.5.The area under the SOFA score curve is 0.82,the sensitivity is 73.7%,the specificity is 75%,and the optimal threshold is 6.5.The area under the RDW curve is 0.622,the sensitivity is 26.3%,the specificity is 92.5%,and the optimal threshold is 15.50.The area under the ALB curve is0.765,the sensitivity is 71.9%,the specificity is 72.5%,and the optimal threshold is 2.57.According to the optimal threshold of ROC curve,RAR≥5.34%/g/d L is defined as high RAR level group,and RAR<5.34%/g/dl is defined as low RAR level group.By multivariate logistic regression analysis,high RAR level(P=0.001,OR=37.765,95%CI:4.176～341.507)is an independent risk factor for death of sepsis complicated with ARDS.Conclusion: 1.When RAR≥4.70%/g/d L,it has good predictive value for early diagnosis of sepsis co mplicated with ARDS.2.RAR is an independent risk factor for sepsis complicated with ARDS.3.When R AR≥5.34%/g/d L,it may be helpful to predict the death of sepsis complicated with ARDS. |
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