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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 307-312. doi: 10.19723/j.issn.1671-167X.2024.02.016

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Risk factors for acute respiratory distress syndrome in patients with traumatic hemorrhagic shock

Xiaoqian SI1,2,Xiujuan ZHAO1,*(),Fengxue ZHU1,Tianbing WANG3   

  1. 1. Department of Critical Care Medicine, Trauma Medicine Center, Peking University People's Hospital, Beijing 100044, China
    2. Peking University School of Basic Medical Sciences, Beijing 100191, China
    3. Trauma Medicine Center, Peking University People's Hospital; National Center for Trauma Medicine of China; Key Laboratory of Trauma and Neural Regeneration (Peking University) of Ministry of Education; Beijing 100044, China
  • Received:2023-04-27 Online:2024-04-18 Published:2024-04-10
  • Contact: Xiujuan ZHAO E-mail:zxj_0515@163.com
  • Supported by:
    the Transverse Research Project(2022-Z-42);the Research And Development Funds of Peking University People's Hospital(RDJ2022-26)

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Abstract:

Objective: To investigate the risk factors of acute respiratory distress syndrome (ARDS) after traumatic hemorrhagic shock. Methods: This was a retrospective cohort study of 314 patients with traumatic hemorrhagic shock at Trauma Medicine Center, Peking University People's Hospital from December 2012 to August 2021, including 152 male patients and 162 female patients, with a median age of 63.00 (49.75-82.00) years. The demographic data, past medical history, injury assessment, vital signs, laboratory examination and other indicators of these patients during hospitalization were recorded. These patients were divided into two groups, ARDS group (n=89) and non-ARDS group (n=225) according to whether there was ARDS within 7 d of admission. Risk factors for ARDS were identified using Logistic regression. The C-statistic expressed as a percentage [area under curve (AUC) of the receiver operating characteristic (ROC) curve] was used to assess the discrimination of the model. Results: The incidence of ARDS after traumatic hemorrhagic shock was 28.34%. Finally, Logistic regression model showed that the independent risk factors of ARDS after traumatic hemorrhagic shock included male, history of coronary heart disease, high acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, road traffic accident and elevated troponin Ⅰ. The OR and 95% confidence intervals (CI) were 4.01 (95%CI: 1.75-9.20), 5.22 (95%CI: 1.29-21.08), 1.07 (95%CI: 1.02-1.57), 2.53 (95%CI: 1.21-5.28), and 1.26 (95%CI: 1.02-1.57), respectively; the P values were 0.001, 0.020, 0.009, 0.014, and 0.034, respectively. The ROC curve was used to analyze the value of each risk factor in predicting ARDS. It was found that the AUC for predicting ARDS after traumatic hemorrhagic shock was 0.59 (95%CI: 0.51-0.68) for male, 0.55 (95%CI: 0.46-0.64) for history of coronary heart disease, 0.65 (95%CI: 0.57-0.73) for APACHE Ⅱ score, 0.58 (95%CI: 0.50-0.67) for road traffic accident, and 0.73 (95%CI: 0.66-0.80) for elevated troponin Ⅰ, with an overall predictive value of 0.81 (95%CI: 0.74-0.88). Conclusion: The incidence of ARDS in patients with traumatic hemorrhagic shock is high, and male, history of coronary heart disease, high APACHE Ⅱ score, road traffic accident and elevated troponin Ⅰ are independent risk factors for ARDS after traumatic hemorrhagic shock. Timely monitoring these indicators is conducive to early detection and treatment of ARDS after traumatic hemorrhagic shock.

Key words: Acute respiratory distress syndrome, Trauma, Hemorrhagic shock, Risk factors

CLC Number: 

  • R563.8

Table 1

Comparison of risk factors between traumatic hemorrhagic shock patients with and without ARDS"

Characters ARDS group (n=89) Non-ARDS group (n=225) Statistics P value
Gender 15.907 <0.001
  Male 59 (66.29) 93 (41.33)
  Female 30 (33.71) 132 (58.67)
Age/years 63.00 (51.00, 82.00) 63.00 (49.00, 82.00) 0.106 0.916
Preadmission conditions
  Chronic renal insufficiency 2 (2.25) 2 (0.89) 0.936 0.333
  Coronary heart disease 10 (11.24) 8 (3.56) 6.962 0.008
  Hypertension 28 (31.46) 74 (32.89) 0.059 0.808
  Diabetes mellitus 9 (10.11) 36 (16.00) 1.801 0.180
Causes of trauma
  Road traffic accident 35 (39.33) 60 (26.67) 4.779 0.024
  Falling from height 15 (16.85) 32 (14.22) 0.347 0.556
  Falling from a standing position 34 (38.20) 112 (49.78) 3.435 0.064
  Others (crush, stab, animal bite) 5 (5.62) 21 (9.33) 1.159 0.282
Main bleeding site
  Thoracic 24 (26.97) 31 (13.78) 7.678 0.006
  Abdominal 13 (14.61) 21 (9.33) 1.837 0.175
  Pelvic 10 (11.23) 21 (9.33) 0.259 0.610
  Limbs 35 (39.33) 109 (48.44) 2.347 0.126
  Others (blood vessels, skin, soft tissue) 7 (7.86) 43 (19.11) 6.024 0.014
Mean arterial pressure/mmHg 61.20 (50.82, 71.58) 67.30 (58.01, 76.59) 1.894 0.058
Heart rate/(beats/min) 124.00 (108.00, 140.00) 109.50 (94.00, 125.00) 3.926 <0.001
Shock index 1.16 (0.90, 1.67) 1.03 (0.76, 1.26) 3.318 0.001
Perfusion index 3.7 (0.7, 4.3) 4.0 (1.2, 4.4) 1.788 0.074
Central venous pressure/mmHg 4.00 (2.25, 6.75) 5.00 (3.00, 7.00) 2.151 0.032
Respiration rate/(breaths/min) 25.00 (21.50, 30.50) 22.00 (19.00, 25.00) 2.715 0.007
Temperature/℃ 37.70 (37.00, 38.30) 37.50 (37.00, 38.00) 1.472 0.141
Laboratory test
  Leukocyte count/(×109/L) 9.96 (5.71, 14.21) 10.73 (8.23, 13.23) 3.206 0.001
  Lymphocyte count/(×109/L) 0.79 (0.54, 1.04) 0.76 (0.44, 1.08) 0.559 0.576
  Hemoglobin/(g/L) 92.00 (76.38, 107.63) 96.00 (80.38, 111.63) 0.484 0.629
  Platelet count/(×109/L) 131.50 (87.50, 175.50) 132.00 (91.00, 173.00) 0.302 0.762
  Serum albumin/(g/L) 29.65 (23.20, 33.43) 31.50 (27.05, 36.00) 2.937 0.003
  Serum creatinine/(μmol/L) 76.00 (61.00, 117.00) 69.00 (54.50, 89.50) 2.492 0.013
  Total bilirubin/(μmol/L) 15.05 (9.95, 20.20) 14.30 (10.85, 21.00) 0.472 0.637
  Fibrinogen/(mg/dL) 175.00 (92.00, 258.00) 180.50 (106.50, 254.50) 1.874 0.061
  Cardiac troponin Ⅰ/(μg/L) 0.194 (0.032, 0.697) 0.020 (0.006, 0.094) 6.237 <0.001
  Lactate/(mmol/L) 3.10 (1.95, 3.90) 3.00 (1.60, 6.18) 0.803 0.422
  C-reactive protein/(mg/L) 41.8 (13.45, 87.65) 28.7 (11.0, 67.03) 1.230 0.219
  Interleukin-6/(ng/L) 112.95 (48.45, 189.35) 87.50 (36.80, 156.40) 1.362 0.172
ISS 27.16 (19.66, 34.66) 22.00 (14.50, 29.50) 3.681 <0.001
APACHE Ⅱ score 19.00 (17.00, 23.00) 16.00 (12.00, 20.00) 4.779 <0.001
Hospital mortality 15 (16.85) 15 (6.67) 7.659 0.006

Table 2

Establishment of Logistic regression model of ARDS after traumatic hemorrhagic shock"

Characters Univariate analysis Multivariate analysis
P OR (95%CI) β Wald P OR (95%CI)
Male <0.001 2.791 (1.671-4.664) 1.389 10.740 0.001 4.009 (1.747-9.199)
History of coronary heart disease 0.012 3.434 (1.309-9.010) 1.653 5.389 0.020 5.222 (1.293-21.080)
Road traffic accident 0.029 1.782 (1.062-2.992) 0.926 6.048 0.014 2.532 (1.207-5.277)
Thoracic bleeding 0.006 2.311 (1.265-4.220)
Bleeding at other sites 0.018 0.361 (0.156-0.837)
Heart rate 0.017 1.047 (1.008-1.088)
Shock index <0.001 2.446 (1.491-4.014)
Central venous pressure 0.025 0.882 (0.790-0.984)
Respiration rate 0.291 1.158 (0.882-1.519)
Leukocyte count 0.009 1.059 (1.014-1.106)
Serum albumin 0.003 0.943 (0.907-0.980)
Serum creatinine 0.052 1.005 (1.000-1.009)
Cardiac troponin Ⅰ 0.002 1.420 (1.133-1.779) 0.234 4.489 0.034 1.264 (1.018-1.569)
ISS <0.001 1.045 (1.019-1.071)
APACHE Ⅱ score <0.001 1.094 (1.048-1.141) 0.071 6.852 0.009 1.074 (1.018-1.569)

Figure 1

ROC curve analysis of risk factors for the prediction of ARDS after traumatic hemorrhagic shock ARDS, acute respiratory distress syndrome; ROC, receiver operating characteristic."

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