Application of insulin secretion index in disease assessment, multiple organ failure and prognosis prediction in patients with acute respiratory distress syndrome / 中国医师进修杂志

ABSTRACT

Objective:To investigate the effect of insulin secretion index (HOMA-β) in the evaluation of the condition of patients with acute respiratory distress syndrome (ARDS), multiple organ failure (MOF) and prognosis prediction.Methods:A retrospective analysis of the clinical data of 96 patients with ARDS hospitalized in Hangzhou Hospital of Zhejiang Medical Health Group from January 2019 to February 2021 was divided into MOF group (38 cases) and non-MOF group (58 cases). The baseline HOMA-β, oxygenation index, acute physiology and chronic health score Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA) and 28 d case fatality rate were collected and compared between the two groups. Compare the HOMA-β, oxygenation index, APACHE Ⅱ score, SOFA of ARDS patients with different survival prognosis. Logistic regression model analyzed the influence of HOMA-β, oxygenation index, APACHE Ⅱ, SOFA on the MOF and survival prognosis of ARDS patients. Pearson linear correlation method was used to analyze the relationship between HOMA-β and oxygenation index, APACHE Ⅱ, SOFA in ARDS patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive power of HOMA-β on MOF and prognosis of ARDS patients.Results:The incidence of MOF and 28 d case fatality rate in 96 patients with ARDS were 39.58% (38/96) and 31.25% (31/96), respectively. The HOMA-β and oxygenation index in the MOF group were significantly lower than those in non-MOF group 126.37 ± 28.75 vs. 178.52 ± 32.66, (125.41 ± 18.77) mmHg (1 mmHg = 0.133 kPa) vs. (153.62 ± 26.42) mmHg, while the APACHE Ⅱ, SOFA and 28 d case fatality rate were significantly higher than those in non-MOF group (23.61 ± 4.68) points vs. (10.96 ± 2.85) points, (11.24 ± 1.65) points vs. (5.62 ± 0.87) points and 65.79% (25/38) vs. 10.34% (6/58), and there were statistical differences ( P<0.05). The HOMA-β and oxygenation index in dead ARDS patients were significantly lower than those in surviving ARDS patients 89.62 ± 21.17 vs. 195.43 ± 35.64 and (121.66 ± 21.06) mmHg vs. (158.87 ± 28.71) mmHg, the APACHE Ⅱ and SOFA were significantly higher than those in surviving ARDS patients (25.78 ± 5.42) points vs. (8.84 ± 2.51) points, (12.38 ± 1.22) points vs. (4.88 ± 0.83) points, and there were statistical differences ( P<0.05). Logistic regression model analysis showed that HOMA-β, oxygenation index, APACHE Ⅱ, SOFA of ARDS patients were all influencing factors of MOF and survival prognosis ( P<0.05). The results of Pearson linear correlation analysis showed that HOMA-β in ARDS patients was positively correlated with its oxygenation index ( P<0.05), and its APACHE Ⅱ and SOFA were negatively correlated ( P<0.05). ROC curve analysis results show that HOMA-β in ARDS patients has a high predictive power for their MOF and prognosis. Conclusions:The level of HOMA-β in ARDS patients is low, and it is closely related to its condition, MOF occurrence and survival prognosis. It can be used as a reference index for disease assessment and MOF and prognosis prediction of ARDS patients.