背景:ARDS(急性呼吸窘迫综合征)是最严重的急性低氧性呼吸衰竭。大多数与ARDS相关的研究都排除了血液病患者,更不用说异基因造血干细胞移植(allo-HSCT)受者了。由于诊断和治疗的局限性,许多患有严重低氧性呼吸衰竭的患者不符合柏林的定义。ARDS的新定义,消除一些诊断限制,是2023年提出的。根据2023年ARDS的新定义,我们调查了allo-HSCT受者ARDS的临床特征,并报告了分别由柏林定义和ARDS新定义定义的allo-HSCT受者院内死亡的危险因素.
方法:从2016年1月至2020年12月,本研究回顾性纳入了三家教学医院的135名新定义的allo-HSCT接受者和87名柏林定义的接受者。变量(人口统计信息,血液病和ARDS发作的特征,单因素Logistic回归分析中P<0.05的实验室测试和SOFA评分)包括在多因素逐步Logistic回归分析中。报告了调整后的比值比(OR)和95%置信区间(95%CI)。
结果:在新的定义下,SOFA评分(OR=1.351,95%CI:1.146~1.593,P<0.01)是ARDS患者allo-HSCT后院内死亡的独立危险因素,SpO2/FiO2(OR=0.984,95%CI:0.972-0.996,P<0.01)为保护因素。与骨髓来源的干细胞输注相比,外周来源的干细胞输注是ARDS移植后住院死亡率的保护因素(OR=0.726,95%CI:0.164-3.221,P=0.04)。根据柏林的定义,PaO2/FiO2(OR=0.977,95%CI:0.961-0.993,P=0.01,乳酸(OR=7.337,95%CI:1.313-40.989,P<0.01)和AST(OR=1.165,95%CI:1.072-1.265,P<0.01)与住院死亡率独立相关。
结论:我们在allo-HSCT受者中发现的这些预后危险因素可能有助于更密切的监测和ARDS预防策略。这些发现需要前瞻性的确认,大样本量研究。
BACKGROUND: ARDS (acute respiratory distress syndrome) is the most severe form of acute hypoxic respiratory failure. Most studies related to ARDS have excluded patients with hematologic diseases, let alone allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Numerous patients experiencing severe hypoxic respiratory failure do not meet the Berlin definition due to the limitations of diagnosis and treatment. A new definition of ARDS, remove some diagnosis restrictions, was proposed in 2023. Based on the 2023 new definition of ARDS, we investigated the clinical features of ARDS in allo-HSCT recipients and reported risk factors for in-hospital mortality in allo-HSCT recipients defined by the Berlin definition and the new definition of ARDS respectively.
METHODS: From Jan 2016 to Dec 2020, 135 allo-HSCT recipients identified with the new definition and 87 identified with the Berlin definition at three teaching hospitals were retrospectively included in this study. Variables (demographic information, characteristics of hematologic disease and ARDS episode, laboratory tests and SOFA score) with P < 0.05 in univariate logistic regression analysis were included in multivariate stepwise logistic regression analysis. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported.
RESULTS: Under the new definition, SOFA score (OR = 1.351, 95% CI: 1.146-1.593, P < 0.01) were found as an independent risk factor for in-hospital mortality in ARDS after allo-HSCT, while SpO2/FiO2 (OR = 0.984, 95% CI: 0.972-0.996, P < 0.01) was a protective factor. The infusion of peripheral-derived stem cells was found to be a protective factor against in-hospital mortality in post-transplantation ARDS compared with the infusion of bone marrow-derived stem cells (OR = 0.726, 95% CI: 0.164-3.221, P = 0.04). Under the Berlin definition, PaO2/FiO2 (OR = 0.977, 95% CI: 0.961-0.993, P = 0.01, lactate (OR = 7.337, 95% CI: 1.313-40.989, P < 0.01) and AST (OR = 1.165, 95% CI: 1.072-1.265, P < 0.01) were independently associated with in-hospital mortality.
CONCLUSIONS: These prognostic risk factors we found in allo-HSCT recipients may contribute to closer monitoring and ARDS prevention strategies. These findings require confirmation in prospective, large sample size studies.