Influencing Factors of Prognosis in Patients with Sepsis-Associated Acute Respiratory Distress Syndrome and the Predictive Value of Regression Equation

LIANG Shuangshuang; JIAN Honghui; ZHENG Haigang

doi:10.16458/j.cnki.1007-0893.2025.14.006

Abstract：Objective To explore the influencing factors of prognosis in patients with sepsis-associated acute respiratory distress syndrome(ARDS)and the predictive value of the regression equation.Methods A total of 325 patients with sepsis-associated ARDS who were treated in Huaibin County People's Hospital from October 2021 to November 2024 were selected as the research subjects.Their clinical data were collected for a retrospective study.The patients were divided into a survival group(263 cases)and a death group(62 cases)based on their survival status within one week after emergency treatment.The clinical data of the two groups were compared,and the risk factors were analyzed using multivariate Logistic regression analysis.The predictive value of the regression equation was analyzed using the receiver operating characteristic(ROC)curve.Results The proportion of patients with lower respiratory tract infection,pulmonary ARDS,and continuous renal replacement therapy(CRRT)in the death group were higher than those in the survival group.The time from onset to admission and the time to admission to the intensive care unit(ICU)in the death group were longer than those in the survival group.The fraction of inspired oxygen(FiO2),extravascular lung water index(EVLWI),and acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ)score in the death group were higher than those in the survival group.The arterial partial pressure of oxygen(PaO2)and the oxygenation index(PaO2/FiO2)in the death group were lower than those in the survival group,and all these differences were statistically significant(P<0.05).The multivariate Logistic regression analysis showed that the independent risk factors for prognosis in patients with sepsis-associated ARDS included lower respiratory tract infection(OR=2.401,P<0.001),pulmonary ARDS(OR=2.807,P=0.044),longer time from onset to admission(OR=2.197,P<0.001),and lower PaO2/FiO2(OR=2.683,P=0.002).The regression equation model was:Logit(P)=-10.076+lower respiratory tract infection×0.876+ARDS type×1.032+time from onset to admission×0.787+PaO2/FiO2×0.987.The ROC curve was drawn based on the diagnostic probability Logit(P)to predict the prognosis of patients with sepsis-associated ARDS.When Logit(P)>12.92,the area under the curve(AUC)value and χ2 were 0.869 and 12.541,respectively,with a 95%confidence interval(CI)of 0.280 to 0.904.The diagnostic sensitivity and specificity were 77.42%and 83.27%,respectively.Conclusion The independent risk factors for prognosis in patients with sepsis-associated ARDS include lower respiratory tract infection,pulmonary ARDS,longer time from onset to admission,and lower PaO2/FiO2.The regression equation constructed based on these factors has a high predictive value,and clinical intervention with effective and personalized treatment plans can be implemented as early as possible for high-risk patients to improve their prognosis.