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Objective To investigate the value of nomogram based on lactate-to-albumin ratio (L/A) combined with neutrophil-to-lymphocyte ratio (NLR) for predicting the early prognosis of patients with acute respiratory distress syndrome (ARDS). Methods A total of 115 patients with ARDS admitted in the Department of Critical Care Medicine of the Second Hospital of Lanzhou University from March 2018 to June 2022 were retrospectively analyzed, and divided into survival group (n=62) and death group (n=53) depending on their clinical outcomes at 28 days after treatment. The general clinical data, blood routine, serum albumin, blood gas analysis, sequential organ failure (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Murray lung injury (Murray) score, number of organ failure, cause of ARDS, ICU stay, mechanical ventilation time, 28-day mortality were collected within 24 hours of ICU admission. At the same time, the L/A and NLR were calculated. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors affecting the prognosis of ARDS and to construct a clinical prediction model. The nomogram was drawn to visualize the clinical model. Finally, receiver operating characteristic (ROC) curve and calibration curve were used to verify the accuracy of the nomogram, a decision curve analysis was also performed to evaluate the clinical usefulness of the nomogram. Results The age, APACHE II, SOFA, and Murray scores, number of organ failure, proportion of pulmonary ARDS, neutrophil count (NEU), NLR, L/A, and blood lactate level in death group were significantly higher than those in survival group, the oxygenation index (PaO2/FiO2), proportion of extra pulmonary ARDS, lymphocyte count (LYM), and platelet count (PLT) were significantly lower than those in survival group (P<0.05). Univariate analysis and multivariate logistic regression analysis showed that age, SOFA score, the cause of ARDS, NLR and L/A were the independent risk factors for prognosis of ARDS (P<0.05). In addition, ROC curve analysis showed that the area under the ROC curve (AUC) of age, SOFA score, cause of ARDS, NLR and L/A in predicting the 28-day prognosis of ARDS patients were 0.651, 0.777, 0.579, 0.727 and 0.753, respectively. But the AUC of ARDS cause combined with age and SOFA score was 0.830, which was significantly higher than that of age (P=0.000) and ARDS cause (P=0.000), but there was no significant difference in SOFA score (P=0.064). The nomogram based on all these five independent risk factors was constructed, which was defined as Model 1. At the same time, the combined model constructed by age, cause of ARDS and SOFA was defined as Model 2. The ROC comparison between the two showed that Model 1 had a higher ability to predict the prognosis of ARDS (AUC: 0.889 vs. 0.830), and the calibration curve and decision curve analysis showed that Model 1 had better accuracy and potential application value in predicting the prognosis of ARDS patients. Conclusion The nomogram constructed based on L/A combined with NLR can predict the early prognosis of patients with ARDS, and has high predictive efficiency and clinical benefit.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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