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Abstract：
The present study evaluated the predictive value of the combination of the lung injury prediction score (LIPS) and receptor for advanced glycation end-products (RAGE) for the occurrence of acute respiratory distress syndrome (ARDS) in critically ill patients with ARDS risk factors. A total of 551 patients with risk factors of ARDS were divided into an ARDS group and a non-ARDS group. LIPS was computed within 6 h of admission into the ICU, and the plasma concentration of RAGE was detected within 24 h of admission. Multivariate analysis was performed to identify independent associations, and the predictive values for ARDS occurrence were assessed with receiver operating characteristic (ROC) curve. Within 7 days after admission into the ICU, ARDS occurred in 176 patients (31.9%). Multivariate analysis demonstrated that LIPS [odds ratio (OR), 1.282; 95% confidence interval (CI), 1.108-1.604], RAGE levels (OR, 2.359; 95% CI, 1.351-4.813) and Acute Physiology and Chronic Health Evaluation II score (OR, 1.167; 95% CI, 1.074-1.485) were independently associated with ARDS occurrence. ROC curves demonstrated that the area under curve (AUC) of LIPS, RAGE levels and their combination was 0.714 [standard error (SE), 0.023; 95% CI, 0.670-0.759], 0.709 (SE, 0.025; 95% CI, 0.660-0.758) and 0.889 (SE, 0.014; 95% CI, 0.861-0.917), respectively. The AUC of LIPS combined with RAGE levels was significantly higher compared with those of LIPS (0.889 vs. 0.714; Z=6.499; P<0.001) and RAGE (0.889 vs. 0.709; Z=6.282; P<0.001) levels alone. In conclusion, both LIPS and RAGE levels were independently associated with ARDS occurrence in critically ill patients with ARDS risk factors, and had medium predictive values for ARDS occurrence. Combination of LIPS with RAGE levels increased the predictive value for ARDS occurrence.
摘要：
本研究评估了肺损伤预测评分(LIPS)和糖基化终末产物受体(RAGE)联合对急性呼吸窘迫综合征(ARDS)危险因素危重患者发生ARDS的预测价值。将551例具有ARDS危险因素的患者分为ARDS组和非ARDS组。LIPS在进入ICU后6小时内计算，入院24h内检测血浆RAGE浓度。进行多变量分析以确定独立的关联，用受试者工作特征（ROC）曲线评估ARDS发生的预测值。入住ICU后7天内,176例患者发生ARDS(31.9%)。多变量分析表明，LIPS[比值比(OR)，1.282；95%置信区间(CI)，1.108-1.604],愤怒程度(或，2.359；95%CI，1.351-4.813）和急性生理学和慢性健康评估II评分（OR，1.167；95%CI，1.074-1.485）与ARDS发生独立相关。ROC曲线显示LIPS的曲线下面积(AUC),RAGE水平及其组合为0.714[标准误差（SE），0.023；95%CI，0.670-0.759]，0.709(SE,0.025；95%CI，0.660-0.758）和0.889（SE，0.014；95%CI，0.861-0.917），分别。LIPS联合RAGE水平的AUC明显高于LIPS（0.889vs.0.714；Z=6.499；P<0.001）和RAGE（0.889vs.0.709；Z=6.282；P<0.001）单独水平。总之,在有ARDS危险因素的危重患者中，LIPS和RAGE水平与ARDS发生独立相关，并且对ARDS的发生具有中等预测值。LIPS与RAGE水平的组合增加了ARDS发生的预测价值。
