Evaluation value of severity and prognosis of Lung ultrasound combined with serum NT-proBNP and sFlt-1 on acute respiratory distress syndrome in patient

doi:10.3969/j.issn.1004-583X.2021.12.011

Abstract

Abstract:

Objective To explore the evaluation value of lung ultrasound combined with serum N-terminal pro-brain natriuretic peptide(NT-proBNP) and soluble vascular endothelial growth factor receptor(sFlt-1) in evaluating the severity and prognosis of acute respiratory distress syndrome(ARDS). Methods Totally 138 ARDS patients were enrolled as the research subjects who treated in our hospital from April 2018 to October 2020. The subjects were classified into severe group (OI≤100 mmHg, 58 cases), moderate group (100 mmHg<OI≤200 mmHg, 51 cases), and mild group (200 mmHg<OI≤300 mmHg, 29 cases) based on oxygenation index (OI). Lung ultrasound score(LUS), serum NT-proBNP, and sFlt-1 levels were compared in groups. The 28-day disease outcome of ARDS patients was counted, and ARDS patients were assigned into a poor prognosis group (death, 41 cases) and a good prognosis group (survival, 97 cases) to compare clinical data between groups. Logistic multivariate regression analysis was used to analyze the prognostic factors. A receiver operating characteristic curve(ROC) was drawn to estimate the diagnostic value of LUS combined with NT-proBNP and sFlt-1 levels on ARDS patients prognosis. Results Difference were statistically different in LUS, serum NT-proBNP, and sFlt-1 levels among three groups (P<0.05), which in the severe group were highest in groups (P<0.05), followed by moderate group, and finally the mild group (all P<0.05). Totally 41 (41/138, 29.71%) cases with poor prognosis involved in 138 ARDS patients, Logistic multivariate analysis showed that influencing factors for ARDS patient prognosis were the length of stay in intensive care unit(ICU), LUS, NT-proBNP level, and sFlt-1 level (OR=3.943, 3.736, 3.337, 4.289, P<0.05), the ROC curve showed that the prognostic AUC of the combination of the three on diagnosis of ARDS was 0.896, which was higher than the AUC of LUS, NT-proBNP, and sFlt-1 alone (0.751, 0.844, 0.773). Conclusion For ARDS patients, the combination of the three can assess the severity, and has a high diagnostic efficiency for the prognosis; therefore, it can be used as an important clinical reference index.

Key words: respiratory distress syndrome, adult, prognosis, patient acuity, ultrasonography

CLC Number:

R563.8

Ma Guilan, Min Ju. Evaluation value of severity and prognosis of Lung ultrasound combined with serum NT-proBNP and sFlt-1 on acute respiratory distress syndrome in patient[J]. Clinical Focus, 2021, 36(12): 1110-1113.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2021.12.011

https://huicui.hebmu.edu.cn/EN/Y2021/V36/I12/1110

Figures/Tables 5

References 15

[1]	Huang D, Ma H, Xiao Z, et al. Diagnostic value of cardiopulmonary ultrasound in elderly patients with acute respiratory distress syndrome[J]. BMC Pulm Med, 2018, 18(1):136. doi: 10.1186/s12890-018-0666-9 URL
[2]	Allinovi M, Parise A, Giacalone M, et al. Lung ultrasound may support diagnosis and monitoring of COVID-19 pneumonia[J]. Ultrasound Med Biol, 2020, 46(11):2908-2917. doi: S0301-5629(20)30333-1 pmid: 32807570
[3]	Grasselli G, Tonetti T, Protti A, et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: A multicentre prospective observational study[J]. Lancet Respir Med, 2020, 8(12):1201-1208. doi: 10.1016/S2213-2600(20)30370-2 pmid: 32861276
[4]	张萌, 李聪, 王克诚. 心肺联合超声判断急性呼吸窘迫综合征患者预后的价值[J]. 临床超声医学杂志, 2020, 22(12):911-915.
[5]	Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: The Berlin definition[J]. JAMA, 2012, 307(23):2526-2533. doi: 10.1001/jama.2012.5669 pmid: 22797452
[6]	Hiles M, Culpan AM, Watts C, et al. Neonatal respiratory distress syndrome: Chest X-ray or lung ultrasound? A systematic review[J]. Ultrasound, 2017, 25(2):80-91. doi: 10.1177/1742271X16689374 URL
[7]	Islam M, Levitus M, Eisen L, et al. Lung ultrasound for the diagnosis and management of acute respiratory failure[J]. Lung, 2020, 198(1):1-11. doi: 10.1007/s00408-019-00309-1 URL
[8]	高延秋, 张根生, 李双凤, 等. 血管外肺水指数联合血管内皮生长因子受体1对重症肺炎ARDS合并感染性休克患者预后的评估[J]. 中华急诊医学杂志, 2018, 27(12):1381-1387.
[9]	Elsayed YN, Hinton M, Graham R, et al. Lung ultrasound predicts histological lung injury in a neonatal model of acute respiratory distress syndrome[J]. Pediatr Pulmonol, 2020, 55(11):2913-2923. doi: 10.1002/ppul.v55.11 URL
[10]	Lai CC, Sung MI, Ho CH, et al. The prognostic value of N-terminal proB-type natriuretic peptide in patients with acute respiratory distress syndrome[J]. Sci Rep, 2017, 7(4):44784. doi: 10.1038/srep44784 URL
[11]	杨慧亮, 李颖, 巴晓彤. 急性呼吸窘迫综合征患者血清PCT、 NT-proBNP水平变化及意义[J]. 分子诊断与治疗杂志, 2020, 12(4):469-472, 477.
[12]	Karge A, Beckert L, Moog P, et al. Role of sFlt-1/PIGF ratio and uterine Doppler in pregnancies with chronic kidney disease suspected with Pre-eclampsia or HELLP syndrome[J]. Pregnancy Hypertens, 2020, 22(10):160-166. doi: 10.1016/j.preghy.2020.09.007 URL
[13]	曾天星, 田婵婵, 陈丽珺, 等. 血浆NT-proBNP与急性呼吸窘迫综合征严重程度的相关性分析[J]. 中华肺部疾病杂志(电子版), 2016, 9(4):417-419.
[14]	Umbrello M, Fumagalli J, Pesenti A, et al. Pathophysiology and management of acute respiratory distress syndrome in obese patients[J]. Semin Respir Crit Care Med, 2019, 40(1):40-56. doi: 10.1055/s-0039-1685179 pmid: 31060087
[15]	郭鑫鑫. 血浆sTREM-1、sFLT-1水平与重症肺炎APACHE Ⅱ评分的关联性[J]. 牡丹江医学院学报, 2021, 42(1):71-74.

组别	例数	LUS (分)	NT-proBNP (pg/mL)	sFlt-1 (ng/L)
重度组	58	24.82±4.47	819.31±72.17	603.57±58.49
中度组	51	18.43±3.86^*	729.46±62.47^*	526.78±47.25^*
轻度组	29	12.10±3.15^*#	522.28±70.16^*#	417.32±53.21^*#
F值		102.316	183.092	118.523
P值		<0.01	<0.01	<0.01

组别	例数	LUS (分)	NT-proBNP (pg/mL)	sFlt-1 (ng/L)
重度组	58	24.82±4.47	819.31±72.17	603.57±58.49
中度组	51	18.43±3.86^*	729.46±62.47^*	526.78±47.25^*
轻度组	29	12.10±3.15^*#	522.28±70.16^*#	417.32±53.21^*#
F值		102.316	183.092	118.523
P值		<0.01	<0.01	<0.01

项目	预后不良组 (n=41)	预后良好组 (n=97)	统计值	P值
性别[例(%)]
男女	27(65.85) 14(34.15)	55(56.70) 42(43.30)	χ²=0.193	0.660
年龄(岁)	57.10±7.93	55.83±8.12	t=0.845	0.399
BMI(kg/m²)	22.53±2.72	22.31±2.61	t=0.447	0.656
入住ICU时间(天)	14.20±2.36	11.15±1.72	t=8.482	<0.01
既往史[例(%)]
冠心病史	5(12.20)	11(11.34)	χ²=0.021	0.886
糖尿病史	6(14.63)	9(9.28)	χ²=0.853	0.356
高血压史	9(21.95)	17(17.53)	χ²=0.369	0.543
高血脂症史	8(19.51)	15(15.46)	χ²=0.340	0.560
吸烟史	13(31.70)	24(24.74)	χ²=0.712	0.399
饮酒史	10(24.39)	21(21.65)	χ²=0.124	0.724
呼吸频率(次/min)	25.48±3.24	24.71±3.05	t=1.330	0.186
发病原因[例(%)]
脓毒血症	16(39.02)	36(37.11)
脑血管事件	9(21.95)	22(22.68)	χ²=0.052	0.997
外伤	8(19.51)	20(20.62)
开胸术后	8(19.51)	19(19.59)
MAP(mmHg)	69.27±10.21	72.52±9.71	t=1.770	0.079
PEEP(cmH₂O)	12.57±3.76	11.92±3.57	t=0.962	0.338
PaCO₂(mmHg)	36.18±6.64	39.53±6.97	t=2.616	0.010
PaO₂(mmHg)	69.49±8.06	72.87±8.56	t=2.156	0.033
OI(mmHg)	115.06±9.17	157.96±13.79	t=18.266	<0.01
LUS(分)	24.98±4.83	17.11±3.76	t=16.841	<0.01
NT-proBNP(pg/mL)	821.73±62.97	546.85±51.76	t=26.687	<0.01
sFlt-1(ng/L)	605.17±49.84	451.43±50.32	t=16.448	<0.01

项目	预后不良组 (n=41)	预后良好组 (n=97)	统计值	P值
性别[例(%)]
男女	27(65.85) 14(34.15)	55(56.70) 42(43.30)	χ²=0.193	0.660
年龄(岁)	57.10±7.93	55.83±8.12	t=0.845	0.399
BMI(kg/m²)	22.53±2.72	22.31±2.61	t=0.447	0.656
入住ICU时间(天)	14.20±2.36	11.15±1.72	t=8.482	<0.01
既往史[例(%)]
冠心病史	5(12.20)	11(11.34)	χ²=0.021	0.886
糖尿病史	6(14.63)	9(9.28)	χ²=0.853	0.356
高血压史	9(21.95)	17(17.53)	χ²=0.369	0.543
高血脂症史	8(19.51)	15(15.46)	χ²=0.340	0.560
吸烟史	13(31.70)	24(24.74)	χ²=0.712	0.399
饮酒史	10(24.39)	21(21.65)	χ²=0.124	0.724
呼吸频率(次/min)	25.48±3.24	24.71±3.05	t=1.330	0.186
发病原因[例(%)]
脓毒血症	16(39.02)	36(37.11)
脑血管事件	9(21.95)	22(22.68)	χ²=0.052	0.997
外伤	8(19.51)	20(20.62)
开胸术后	8(19.51)	19(19.59)
MAP(mmHg)	69.27±10.21	72.52±9.71	t=1.770	0.079
PEEP(cmH₂O)	12.57±3.76	11.92±3.57	t=0.962	0.338
PaCO₂(mmHg)	36.18±6.64	39.53±6.97	t=2.616	0.010
PaO₂(mmHg)	69.49±8.06	72.87±8.56	t=2.156	0.033
OI(mmHg)	115.06±9.17	157.96±13.79	t=18.266	<0.01
LUS(分)	24.98±4.83	17.11±3.76	t=16.841	<0.01
NT-proBNP(pg/mL)	821.73±62.97	546.85±51.76	t=26.687	<0.01
sFlt-1(ng/L)	605.17±49.84	451.43±50.32	t=16.448	<0.01

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
入住ICU时间	1.372	0.361	14.444	0.015	3.943	1.362	6.524
LUS	1.318	0.312	17.845	0.002	3.736	2.631	4.841
NT-proBNP	1.205	0.297	16.461	0.006	3.337	2.776	3.898
sFlt-1	1.456	0.307	22.493	<0.01	4.289	2.283	6.295