PDF(Pubmed)
Abstract：
UNASSIGNED: The role of corticosteroids in acute respiratory distress syndrome (ARDS) remains contentious. This study aims to investigate the prognostic significance of immune deficiency in patients with ARDS and its response to varying doses of corticosteroids.
UNASSIGNED: This single-center, retrospective cohort study enrolled 657 ARDS patients from January 24, 2008, to September 12, 2022, at Zhongshan Hospital of Fudan University, Shanghai, China. The patients were categorized into a discovery dataset (n=357) and a validation dataset (n=300), based on admission date. Further validation of the results in the validation dataset was used to enhance the credibility of the study conclusions. The study examined the association between immune deficiency and the patients\' clinical characteristics, treatment measures, and prognosis. The primary outcome was 28-day mortality post disease onset. Data analysis was conducted from June 15, 2023 to August 15, 2023.
UNASSIGNED: The initial risk factor analysis in the discovery dataset was primarily based on the clinical characteristics, and the results suggested that immune deficiency likely impacted overall survival among patients receiving different doses of corticosteroid treatment. Multivariate analysis identified immune deficiency as an independent prognostic factor for overall survival in both the discovery and validation datasets. The final analysis revealed that patients with mild to moderate ARDS [discovery dataset: hazard ratio (HR) =1.719; 95% confidence interval (CI): 1.229-2.406; log-rank test P=0.001; validation dataset: HR =1.874; 95% CI: 1.238-2.837; log-rank test P=0.002] or severe ARDS (discovery dataset: HR =1.874; 95% CI: 1.007-3.488; log-rank test P=0.04; validation dataset: HR =1.698; 95% CI: 1.042-2.768; log-rank test P=0.03) with immune deficiency exhibited lower overall survival rates. Patients with mild to moderate ARDS and immune deficiency showed greater benefits from low-dose corticosteroid treatment (HR =0.409; 95% CI: 0.249-0.671; P<0.001 for interaction), whereas those with severe ARDS and immune deficiency benefitted from both low and high-dose treatments (low corticosteroid: HR =0.299; 95% CI: 0.136-0.654; high corticosteroid: HR =0.458; 95% CI: 0.214-0.981; P=0.005 for interaction).
UNASSIGNED: Immune deficiency is an independent risk factor in ARDS. Incorporating it into the disease severity grading system based on the Berlin criteria may enhance personalized treatment approaches for ARDS patients. These findings warrant further validation through prospective, large-scale, multicenter randomized controlled trials (RCTs).
UNASSIGNED: This single-center, retrospective cohort study enrolled 657 ARDS patients from January 24, 2008, to September 12, 2022, at Zhongshan Hospital of Fudan University, Shanghai, China. The patients were categorized into a discovery dataset (n=357) and a validation dataset (n=300), based on admission date. Further validation of the results in the validation dataset was used to enhance the credibility of the study conclusions. The study examined the association between immune deficiency and the patients\' clinical characteristics, treatment measures, and prognosis. The primary outcome was 28-day mortality post disease onset. Data analysis was conducted from June 15, 2023 to August 15, 2023.
UNASSIGNED: The initial risk factor analysis in the discovery dataset was primarily based on the clinical characteristics, and the results suggested that immune deficiency likely impacted overall survival among patients receiving different doses of corticosteroid treatment. Multivariate analysis identified immune deficiency as an independent prognostic factor for overall survival in both the discovery and validation datasets. The final analysis revealed that patients with mild to moderate ARDS [discovery dataset: hazard ratio (HR) =1.719; 95% confidence interval (CI): 1.229-2.406; log-rank test P=0.001; validation dataset: HR =1.874; 95% CI: 1.238-2.837; log-rank test P=0.002] or severe ARDS (discovery dataset: HR =1.874; 95% CI: 1.007-3.488; log-rank test P=0.04; validation dataset: HR =1.698; 95% CI: 1.042-2.768; log-rank test P=0.03) with immune deficiency exhibited lower overall survival rates. Patients with mild to moderate ARDS and immune deficiency showed greater benefits from low-dose corticosteroid treatment (HR =0.409; 95% CI: 0.249-0.671; P<0.001 for interaction), whereas those with severe ARDS and immune deficiency benefitted from both low and high-dose treatments (low corticosteroid: HR =0.299; 95% CI: 0.136-0.654; high corticosteroid: HR =0.458; 95% CI: 0.214-0.981; P=0.005 for interaction).
UNASSIGNED: Immune deficiency is an independent risk factor in ARDS. Incorporating it into the disease severity grading system based on the Berlin criteria may enhance personalized treatment approaches for ARDS patients. These findings warrant further validation through prospective, large-scale, multicenter randomized controlled trials (RCTs).
摘要：
■皮质类固醇在急性呼吸窘迫综合征（ARDS）中的作用仍存在争议。本研究旨在探讨ARDS患者免疫缺陷的预后意义及其对不同剂量皮质类固醇的反应。
■这个单中心，回顾性队列研究纳入2008年1月24日至2022年9月12日复旦大学附属中山医院657例ARDS患者，上海,中国。将患者分为发现数据集（n=357）和验证数据集（n=300），根据录取日期。对验证数据集中的结果进行进一步验证，以提高研究结论的可信度。该研究检查了免疫缺陷与患者临床特征之间的关系，处理措施,和预后。主要结果是疾病发作后28天死亡率。数据分析于2023年6月15日至2023年8月15日进行。
■发现数据集中的初始风险因素分析主要基于临床特征，结果提示免疫缺陷可能影响接受不同剂量皮质类固醇治疗的患者的总生存期.多变量分析确定免疫缺陷是发现和验证数据集中总生存期的独立预后因素。最终分析显示患有轻度至中度ARDS的患者[发现数据集：风险比（HR）=1.719；95％置信区间（CI）：1.229-2.406；对数秩检验P=0.001；验证数据集：HR=1.874；95％CI：1.238-2.837；对数秩检验P=0.002]或重度ARDS（发现数据集：HR=1.8；95％CI：1.007-0.04；总体轻度至中度ARDS和免疫缺陷的患者从低剂量皮质类固醇治疗中显示出更大的益处（HR=0.409;95％CI：0.249-0.671;相互作用P<0.001），而患有严重ARDS和免疫缺陷的患者可从低剂量和高剂量治疗中获益(低皮质类固醇:HR=0.299;95%CI:0.136-0.654;高皮质类固醇:HR=0.458;95%CI:0.214-0.981;交互作用P=0.005).
■免疫缺陷是ARDS的独立危险因素。将其纳入基于柏林标准的疾病严重程度分级系统可能会增强ARDS患者的个性化治疗方法。这些发现需要通过前瞻性的，大规模,多中心随机对照试验（RCTs）。
■这个单中心，回顾性队列研究纳入2008年1月24日至2022年9月12日复旦大学附属中山医院657例ARDS患者，上海,中国。将患者分为发现数据集（n=357）和验证数据集（n=300），根据录取日期。对验证数据集中的结果进行进一步验证，以提高研究结论的可信度。该研究检查了免疫缺陷与患者临床特征之间的关系，处理措施,和预后。主要结果是疾病发作后28天死亡率。数据分析于2023年6月15日至2023年8月15日进行。
■发现数据集中的初始风险因素分析主要基于临床特征，结果提示免疫缺陷可能影响接受不同剂量皮质类固醇治疗的患者的总生存期.多变量分析确定免疫缺陷是发现和验证数据集中总生存期的独立预后因素。最终分析显示患有轻度至中度ARDS的患者[发现数据集：风险比（HR）=1.719；95％置信区间（CI）：1.229-2.406；对数秩检验P=0.001；验证数据集：HR=1.874；95％CI：1.238-2.837；对数秩检验P=0.002]或重度ARDS（发现数据集：HR=1.8；95％CI：1.007-0.04；总体轻度至中度ARDS和免疫缺陷的患者从低剂量皮质类固醇治疗中显示出更大的益处（HR=0.409;95％CI：0.249-0.671;相互作用P<0.001），而患有严重ARDS和免疫缺陷的患者可从低剂量和高剂量治疗中获益(低皮质类固醇:HR=0.299;95%CI:0.136-0.654;高皮质类固醇:HR=0.458;95%CI:0.214-0.981;交互作用P=0.005).
■免疫缺陷是ARDS的独立危险因素。将其纳入基于柏林标准的疾病严重程度分级系统可能会增强ARDS患者的个性化治疗方法。这些发现需要通过前瞻性的，大规模,多中心随机对照试验（RCTs）。
