Introduction
Materials and methods
Study design and participants
Measurement of serum activin-a concentrations
Outcomes and statistical analysis
Results
Baseline characteristics and clinical features of ARDS patients
Variables | Total patients (n = 97) |
---|---|
Age, years | 67.2 (64.3–70.1) |
Sex, Male, N(%) | 63 (64.3%) |
BMI, kg/m2 | 22.5 (21.7–23.4) |
Underlying lung disease, N(%) | |
Lung cancer | 17 (17.4%) |
Chronic obstructive lung disease | 7 (7.1%) |
Idiopathic pulmonary fibrosis | 7 (7.1%) |
Tuberculosis-destroyed lung | 4 (4.1%) |
Metastatic cancer to lung | 5 (5.1%) |
Others | 15 (15.3%) |
Comorbidities, N(%) | |
Hypertension | 39 (39.8%) |
Diabetes mellitus | 25 (25.5%) |
Cardiovascular disease | 32 (32.7%) |
Cerebrovascular disease | 10 (10.2%) |
Malignancy | 51 (52.0%) |
Liver cirrhosis | 9 (9.2%) |
Chronic kidney disease | 18 (18.4%) |
Intubation, N(%) | 91 (92.9%) |
Indication for intubation, N(%) | |
Type 1 respiratory failure | 83 (84.7%) |
Type 2 respiratory failure | 8 (8.2%) |
Cause of ARDS, N(%) | |
Direct lung injury | 86 (87.8%) |
Indirect lung injury | 11 (12.2%) |
Severity of ARDS | |
Mild | 3 (3.1%) |
Moderate | 29 (29.6%) |
Severe | 65 (67.3%) |
APACHE II score | 23.9 (21.7–26.1) |
SOFA score | 9.2 (8.2–10.3) |
SAPS II score | 37.8 (33.6–42.1) |
Mechanical ventilation settingb | |
PaO2/FiO2 ratio | 82 (64–114) |
Peak inspiratory pressure, cmH20 | 25 (21–29) |
Tidal volume, mL | 440 (398–542) |
Minute volume, L | 10.0 (9.0–12.0) |
Positive end-expiratory pressure, cmH20 | 7 (5–10) |
Serum Activin-A concentration (pg/mL) | 1525.62 (472.60–2578.64) |
Serum Activin-A concentrationa | 2.89 (2.82–2.96) |
Clinical course of ARDS patients
Variables | Total patients (n = 97) |
---|---|
Use of adjunctive therapies, N(%) | |
Inotropics | 65 (66.3%) |
Corticosteroid | 80 (81.6%) |
Nitric Oxide | 46 (46.9%) |
Prone position | 17 (17.3%) |
Continuous renal replacement therapy | 21 (21.4%) |
Extracorporeal membrane oxygenation | 6 (6.1%) |
Duration of mechanical ventilation | 10 (5–20) |
Extubation, N(%) | 41 (41.8%) |
Tracheostomy, N(%) | 26 (26.5%) |
ICU length of stay, days | 11 (6–17) |
Hospital length of stay, days | 26 (14–50) |
ICU mortality, N(%) | 57 (58.2%) |
Overall In-hospital mortality | 63 (64.3%) |
30-day in-hospital mortality | 45 (45.9%) |
60-day in-hospital mortality | 60 (61.2%) |
Levels of serum activin-a in ARDS patients
Discriminant power of serum activin-a levels in ARDS patients and its association with other clinical variables
Prediction of clinical outcomes with serum activin-a levels
Parameter | In-hospital mortality | ICU mortality | ||||
---|---|---|---|---|---|---|
AUC | 95% CI | p-value | AUC | 95% CI | p-value | |
Activin-A | 0.653 | 0.541, 0.765 | 0.013 | 0.635 | 0.525, 0.745 | 0.024 |
APACHE II | 0.591 | 0.471, 0.710 | 0.142 | 0.548 | 0.432, 0.665 | 0.418 |
Variables | Univariate | Multivariateb | ||
---|---|---|---|---|
Unadjusted OR | P value | Adjusted OR | P value | |
Prognostic values | ||||
APACHE II score | 1.03 (0.99, 1.08) | 0.147 | 1.05 (0.99, 1.10) | 0.061 |
SOFA score | 1.03 (0.95, 1.12) | 0.443 | 1.06 (0.97, 1.16) | 0.186 |
SAPS II score | 1.02 (0.99, 1.04) | 0.103 | 1.01 (0.99, 1.04) | 0.278 |
High serum activin-A (> 708 pg/mL) | 2.61 (1.09, 6.26) | 0.031 | 2.64 (1.04, 6.70) | 0.041 |