Inflammatory Markers as Prognostic Factors for Patients with ARDS / 결핵및호흡기질환

ABSTRACT

BACKGROUND: Acute respiratory distress syndrome (ARDS) is ultimately an inflammatory state. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level are inflammatory markers. The aim of this study was to evaluate the value of the ESR, CRP and APACHE II score as prognostic factors for patient with ARDS. METHODS: We retrospectively analyzed the medical records of 87 ARDS patients. The predictors (APACHE II score, ESR and CRP) and outcomes (mortality and length of the total hospital stay, the ICU stay and mechanical ventilator care) were obtained from the patients' records. The patients were grouped according to survival as the Survivor and Non survivor groups. We compared the APACHE II score, the ESR and the CRP level between the survivor group and the nonsurvivor group. We evaluated the correlation between the predictors and the outcomes. The initial ESR, CRP level and APACHE II score were checked at the time of ICU admission and the second ESR and CRP level were checked 3.3+/-1.2 days after ICU admission. RESULTS: Thirty-eight (43.7%) patients remained alive and 49 (56.3%) patients died. The APACHE II score was significantly lower for the survivor group than that for the non survivor group (14.7+/-7.6 vs 19.6+/-9.1, respectively, p=0.006). The initial ESR and CRP level were not different between the survivor and non-survivor groups (ESR 64.0+/-37.8 mm/hr vs 63.3+/-36.7 mm/hr, respectively, p=0.93, CRP 15.5+/-9.6 mg/dl vs 16.3+/-8.5 mg/dl, respectively, p=0.68). The decrement of the CRP level for the survivor group was greater than that for the non survivor group (-8.23+/-10.0 mg/dl vs -1.46+/-10.1 mg/dl, respectively, p=0.003). Correlation analysis revealed the initial ESR was positively correlated with the length of the total hospital stay and the ICU stay (correlation coefficient of the total hospital days: R=0.43, p=0.001, correlation coefficient of the ICU stay: R=0.39, p=0.014). CONCLUSION: The initial APACHE II score can predict the mortality of ARDS patients, and the degree of the early CRP change can be a predictor of mortality for ARDS patients. The initial ESR has positive correlation with the ARDS patients' duration of the total hospital stay and the ICU stay.