Risk factors for acute respiratory distress syndrome in patients with acute organophosphorus pesticide poisoning

doi:10.3877/cma.j.issn.1674-0785.2025.09.005

Abstract

Abstract:

Objective

To identify the risk factors for acute respiratory distress syndrome (ARDS) in patients with acute organophosphorus pesticide poisoning (AOPP) to provide a theoretical basis for early prevention and diagnosis of this fatal complication.

Methods

The case information of AOPP patients treated in Huangshi Central Hospital from January 2016 to December 2024 was retrospectively collected. Based on the occurrence of ARDS or not, the AOPP patients were divided into an ARDS group (77 cases) and a non-ARDS group (226 cases). The differences in clinical characteristics between the two groups were compared, and their general clinical data and laboratory test results were analyzed. Utilizing univariate and multivariate Logistic regression models, the potential risk factors for ARDS in AOPP were identified. The area under the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of these risk factors for the occurrence of ARDS, and to further explore the risk factors and early diagnostic biomarkers for ARDS in AOPP.

Results

A total of 303 AOPP patients were included, among which 77 (25.4%) were complicated with ARDS. There were statistically significant differences between the two groups in terms of age (P＜0.001), aspiration (P＜0.001), ventilator-associated pneumonia (P＜0.001), albumin (P＜0.001), serum amylase (P＜0.001), and creatinine (P＜0.001). Multivariate Logistic regression showed that age, aspiration, ventilator-associated pneumonia, albumin, serum amylase, and creatinine were independent risk factors for ARDS in patients with AOPP. The area under the ROC curve for predicting ARDS in patients with AOPP by combining the six independent factors was 0.986 (95% confidence interval: 0.986-0.999).

Conclusion

Age, aspiration, ventilator-associated pneumonia, albumin, serum amylase, and creatinine are closely related to the occurrence of ARDS in patients with AOPP. In clinical work, these six factors can be comprehensively considered to help identify high-risk cases early and take timely intervention measures to improve the prognosis of patients.

Key words: Acute organophosphorus pesticide poisoning, Acute respiratory distress syndrome, Risk factors

Kun Peng, Huibin Feng, Lixue Yuan. Risk factors for acute respiratory distress syndrome in patients with acute organophosphorus pesticide poisoning[J]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(09): 668-674.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2025.09.005

https://zhlcyszz.cma-cmc.com.cn/EN/Y2025/V19/I09/668

Figures/Tables 4

一般资料	非ARDS组（226例）	ARDS组（77例）	t/χ²/Z值	P值
年龄（岁， $x ¯$ ±s）	48.8±17.5	56.5±16.7	t=3.365	＜0.001
性别[例（%）]			χ²=0.427	0.513
男性	96（42.5）	36（46.8）
女性	130（57.5）	41（53.2）
误吸[例（%）]			χ²=60.847	＜0.001
否	203（89.8）	37（48.1）
是	23（10.2）	40（51.9）
呼吸机相关性肺炎[例（%）]			χ²=85.582	＜0.001
否	212（93.8）	36（46.8）
是	14（6.2）	41（53.2）
中毒时间（h）	4（2，6）	5（2，8）	Z=1.207	0.228
白蛋白（g/L， $x ¯$ ±s）	41.5±4.9	34.0±8.5	t=9.485	＜0.001
血清淀粉酶（U/L， $x ¯$ ±s）	65（48，94）	272（126，683）	Z=9.696	＜0.001
总胆红素（μmol/L， $x ¯$ ±s）	11.3（8.2，15.4）	10.6（8.4，16.5）	Z=0.072	0.942
肌酐（μmol/L， $x ¯$ ±s）	61（52，73）	79（59，103）	Z=5.317	＜0.001

一般资料	非ARDS组（226例）	ARDS组（77例）	t/χ²/Z值	P值
年龄（岁， $x ¯$ ±s）	48.8±17.5	56.5±16.7	t=3.365	＜0.001
性别[例（%）]			χ²=0.427	0.513
男性	96（42.5）	36（46.8）
女性	130（57.5）	41（53.2）
误吸[例（%）]			χ²=60.847	＜0.001
否	203（89.8）	37（48.1）
是	23（10.2）	40（51.9）
呼吸机相关性肺炎[例（%）]			χ²=85.582	＜0.001
否	212（93.8）	36（46.8）
是	14（6.2）	41（53.2）
中毒时间（h）	4（2，6）	5（2，8）	Z=1.207	0.228
白蛋白（g/L， $x ¯$ ±s）	41.5±4.9	34.0±8.5	t=9.485	＜0.001
血清淀粉酶（U/L， $x ¯$ ±s）	65（48，94）	272（126，683）	Z=9.696	＜0.001
总胆红素（μmol/L， $x ¯$ ±s）	11.3（8.2，15.4）	10.6（8.4，16.5）	Z=0.072	0.942
肌酐（μmol/L， $x ¯$ ±s）	61（52，73）	79（59，103）	Z=5.317	＜0.001

项目	单因素OR（95%CI）	P值	多因素OR（95%CI）	P值
年龄（岁）	1.027（1.011~1.044）	0.001	1.039（1.007~1.073）	0.018
性别
男性	1.0
女性	0.841（0.5~1.414）	0.514
中毒时间（h）	1.024（0.998~1.049）	0.054
误吸
否	1.0		1.0
是	9.542（5.127~17.757）	＜0.001	8.272（3.020~22.662）	＜0.001
呼吸机相关性肺炎
否	1.0		1.0
是	4.802（2.778~8.651）	＜0.001	3.390（1.513~7.413）	0.003
白蛋白（g/L）	0.822（0.781~0.885）	＜0.001	0.899（0.837~0.965）	0.003
血清淀粉酶（U/L）	1.010（1.005~1.013）	＜0.001	1.008（1.005~1.011）	＜0.001
总胆红素（μmol/L）	1.011（0.977~1.053）	0.064
肌酐（μmol/L）	1.035（1.021~1.047）	＜0.001	1.023（1.002~1.044）	0.029

指标	截断值	校正后AUC	95%CI	校正后敏感度（%）	校正后特异度（%）	校正后约登指数
年龄	56.5	0.635	0.562~0.709	58.46	64.99	0.2345
白蛋白	35.2	0.779	0.706~0.847	56.50	90.75	0.4725
血清淀粉酶	119.5	0.868	0.815~0.925	79.05	87.70	0.6675
肌酐	77.5	0.703	0.629~0.777	52.24	80.89	0.3313
误吸		0.762	0.705~0.818	53.30	99.11	0.5241
呼吸机相关性肺炎		0.766	0.710~0.822	53.15	100.00	0.5315
6项指标联合		0.986	0.986~0.999	95.26	95.57	0.9083

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