급성 호흡곤란 증후군 환자에서 염증 표지자의 예후 예측인자로서의 역할
Inflammatory Markers as Prognostic Factors for Patients with ARDS
황재희 (충남대학교)
신지영 (충남의대)
정선영 (충남의대)
이정은 (충남의대)
박희선 (충남의대)
정성수 (충남대학교병원)
김주옥 (충남대학교)
김선영 (충남대병원 내과)
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초록
연구배경: ARDS는 다양한 원인으로 초래되는 급성 염증성 폐 질환으로서 인공호흡기 치료 등의 여러 의학적 발전에도 불구하고 사망률이 40~60%로 예후가 좋지 않다. 이러한 환자들의 예후를 예측하는 방법으로 APACHE, SPAPS, MAM 등 방법이 있지만 간편하지가 않아서, ARDS가 염증성 폐질환이란 점에 착안하여서 염증 지표로 흔히 사용하는 ESR, CRP의 ARDS 환자에서 예후 인자로서의 역할을 평가해 보고자 하였다.방 법: 87명의 ARDS 환자들의 중환자실 입원 당시의 ESR, CRP 결과와 APACHE II score 그리고 추적 검사한 결과를 확인하였다. 또한 대상 환자를 생존한 군과 사망한 군으로 나누어서 생존한 환자군에서 총 입원기간, 중환자실 입원기간, 인공 호흡기 치료 기간과 ESR, CRP, APACHE II score들과의 상관관계 및 ESR, CRP의 변화 추이와 사망률과의 상관 관계에 대해서 연구하였다.결 과: 중환자실 입원 당시의 ESR, CRP로는 ARDS 환자의 사망률을 예측하기가 어렸다. 하지만 CRP는 ARDS로 중환자실 치료 후 생존했던 환자군에서 사망했던 환자군에 비해서 치료 초기에 유의하게 감소하였으며, 중환자실 입원 당시 ESR이 높을수록 ARDS 환자들의 총 입원 기간 및 중환자실 입원기간이 길었다.결 론: CRP의 초기 변화 및 중환자실 입원 당시의 ESR은 ARDS 환자의 예후를 예측하는데 도움이 될 수 있다.
- keywords
- APACHE II, Acute respiratory distress syndrome, C reactive protein, Erythrocyte sedimentation rate, Prognosis
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.
- keywords
- APACHE II, Acute respiratory distress syndrome, C reactive protein, Erythrocyte sedimentation rate, Prognosis
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