Clinical value of left ventricular diastolic function in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome in the elderly / 中华老年医学杂志

ABSTRACT

Objective@#To investigate the clinical and prognosis value of left ventricular diastolic function(LVDF)in predicting the short-term prognosis of sepsis-associated acute lung injury/acute respiratory distress syndrome(ALI/ARDS)in the elderly.@*Methods@#This was a prospective case-control study.A total of 93 elderly patients with sepsis-associated ALI/ARDS, who admitted to our hospital between February 2015 and February 2018, were selected as the study subjects.And they were divided into ALI group(n=52)and ARDS group(n=41). Meanwhile 50 elderly sepsis patients without ALI/ARDS were selected as the control group.Based on the prognosis at the 28th days of admission, patients with ALI/ARDS were divided into a death group and a survival group.General clinical data and left ventricular diastolic function index at different time points after admission were compared between groups.@*Results@#There were statistically significant differences among the ALI group, ARDS group and control group(P<0.05)on admission and at 3 and 7 days after admission in the parameters as the following heart rate, mean arterial pressure(MAP), acute physiology and chronic health evaluation system Ⅱ(APACHEⅡ)score, acute lung injury score(LIS), oxygenation index(PaO2/FiO2), arterial blood lactic acid, blood glucose, serum creatinine, troponin I, B-type brain natriuretic peptide(BNP), procalcitonin(PCT), C-reactive protein(CRP)and early diastolic transmitral velocity to early mitral anulus diastolic velocity ratio(E/Em). APACHEⅡscore, LIS score, blood glucose, troponin I, BNP, PCT, CRP and E/Em were higher in the death group than in the survival group on admission and at 3 and 7 days after admission(all P<0.05). Multivariate logistic regression analysis showed that E/Em on admission and at 3 and 7 days after admission were the independent predictors for mortality in patients with sepsis-associated ALI/ARDS(OR=1.346, 2.150 and 1.954, respectively, P<0.05). ROC curve analysis showed that the area under curve(AUC)of E/Em for predicting death on admission and at 3 and 7 days after admission were 0.687, 0.840 and 0.771, respectively, with the optimal threshold value of 13.26, 14.90 and 14.62, respectively, and the sensitivity and specificity were 74.2% and 67.1%, 81.5% and 84.2%, 79.1% and 87.8%, respectively, .The mortality rate was higher in patients with E/Em above the optimal threshold value than below the optimal threshold value at each time point(all P<0.05).@*Conclusions@#The impairment of LVDF is serious in elderly patients with sepsis-associated ALI/ARDS, may be an independent predictor for recent death in such patients, and has a good predictive value for the prognosis of elderly patients with sepsis-associated ALI/ARDS.