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 casecontrol 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 followingheart rate,mean arterial pressure(MAP),acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) 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).APACHE Ⅱ score,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.