D-D/FIB比值与重症肺炎患者发生急性呼吸窘迫综合征的关系分析OACSTPCD

Objective To explore the relationship between D-dimer(D-D)/fibrinogen(FIB)ratio and acute respiratory distress syndrome(ARDS)in patients with severe pneumonia.Methods The clinical data of 190 patients with severe pneumonia admitted to the hospital from February 2020 to February 2022 were retrospec-tively analyzed.According to the occurrence of ARDS during hospitalization,the patients were divided into ARDS group(85 cases)and non-ARDS group(105 cases).The age,gender,smoking history,drinking histo-ry,complications,acute physiology and chronic health evaluation(APACHE)Ⅱ score and oxygenation index were recorded by the self-made clinical data questionnaire at admission.The laboratory indexes of the patients on admission were recorded,including routine blood index[white blood cell count(WBC),hemoglobin(Hb)level,platelet count(PLT)],inflammation index[C-reactive protein(CRP)level,blood clotting index[pro-thrombin time(PT),prothrombin time ratio(PTR),international standardization ratio(INR),thrombin time(TT),activated partial thromboplastin time(APTT),FIB and D-D levels],and D-D/FIB ratio was calculated.Multivariate Logistic regression was used to analyze the risk factors of ARDS in patients with severe pneumo-nia.Pearson correlation analysis was used to analyze the correlation between D-D/FIB ratio and hypoxia and inflammatory indicators in patients with severe pneumonia.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of D-D/FIB ratio on admission for ARDS in patients with severe pneu-monia.Results The APACHE Ⅱ score of ARDS group was higher than that of non-ARDS group on admis-sion,and the oxygenation index was lower than that of non-ARDS group,and the differences were statistically significant(P＜0.05).The CRP level,PTR,INR,D-D level and D-D/FIB ratio in the ARDS group were high-er than those in the non-ARDS group,and PT was longer than that in the non-ARDS group on admission,and the differences were statistically significant(P＜0.05).There was no significant difference in other laboratory indexes between the two groups(P＞0.05).Multivariate Logistic regression analysis showed that the increase of APACHE Ⅱ score,CRP level and D-D/FIB ratio at admission were independent risk factors for ARDS in pa-tients with severe pneumonia(P＜0.05).Increased oxygenation index was a protective factor for ARDS in pa-tients with severe pneumonia(P＜0.05).Pearson correlation analysis showed that the D-D/FIB ratio was negatively correlated with oxygenation index(r=-0.215,P＜0.05),and positively correlated with CRP(r=0.162,P＜0.05).ROC curve analysis showed that the area under the curve of the D-D/FIB ratio on admission to predict the occurrence of ARDS in patients with severe pneumonia was 0.761(95％CI:0.692-0.830),and when the D-D/FIB ratio was 0.260,the sensitivity and specificity were 90.59％and 57.14％respectively.Con-clusion The D-D/FIB ratio in patients with severe pneumonia is related to the occurrence of ARDS,and the higher the level,the greater the risk of ARDS in patients,which can be used as an auxiliary indicator for early clinical prediction of the risk of ARDS in patients with severe pneumonia.