Table 1. Demographic and Clinical Characteristics of Patients with Direct and Indirect ARDS
Characteristic
|
Total
(N = 225)
|
Direct ARDS
(n=111)
|
Indirect
ARDS (n=114)
|
P value
|
Age (years)
|
66 ± 17
|
64 ± 15
|
67 ± 18
|
0.192
|
Male, n (%)
|
144 (64.0)
|
84 (75.7)
|
60 (52.6)
|
< 0.001
|
BMI
|
24.1 (21.6, 26.8)
|
24.0 (21.0, 26.2)
|
24.4 (21.9, 27.0)
|
0.274
|
Bedridden time (days)
|
8 (4, 15)
|
9 (5, 15)
|
8 (4, 16)
|
0.400
|
APACHE II score
|
23 (19, 28)
|
22 (17, 27)
|
25 (19, 31)
|
0.010
|
SOFA score
|
8 (5, 10)
|
6 (4, 6)
|
9 (6, 11)
|
< 0.001
|
Laboratory data
|
White blood cells (×109/L)
|
16.9 (12.0, 21.5)
|
14.3 (10.1, 20.3)
|
18.2 (14.4, 23.5)
|
< 0.001
|
Neutrophils (×109/L)
|
14.5 (10.4, 19.7)
|
12.8 (9.0, 17.7)
|
16.1 (12.6, 20.8)
|
< 0.001
|
Platelets (×109/L)
|
183.0 (101.0, 253.5)
|
190.0 (120.0, 270.0)
|
167.0 (73.8, 238.0)
|
0.094
|
C-reactive protein(mg/L)
|
120.0 (89.4, 120.0)
|
120.0 (85.0, 120.0)
|
120.0 (92.2, 120.0)
|
0.391
|
Procalcitonin (ng/mL)
|
5.6 (2.0, 16.2)
|
4.1 (1.5, 13.5)
|
7.3 (3.0, 21.2)
|
0.008
|
Serum creatinine (μmol/L)
|
116.7 (66.6, 209.5)
|
90.5 (65.0, 193.0)
|
136.9 (67.9, 248.8)
|
0.019
|
D-dimer (μg/ml)
|
1.9 (0.9, 3.8)
|
1.3 (0.6, 2.5)
|
2.4 (1.3, 5.3)
|
< 0.001
|
PaO2/FiO2
|
158 (103, 199)
|
136 (80, 186)
|
170 (130, 208)
|
< 0.001﹡
|
Mild, n (%)
|
54 (24.0)
|
22 (19.8)
|
32 (28.1)
|
< 0.001﹟
|
Moderate, n (%)
|
116 (51.6)
|
49 (44.1)
|
67 (58.8)
|
|
Severe, n (%)
|
55 (24.4)
|
40 (36.0)
|
15 (13.2)
|
|
DVT, n (%)
|
90 (40.0%)
|
44 (39.6)
|
46 (40.4)
|
0.913
|
ICU length of stay(days)
|
11 (6, 24)
|
13 (7, 25)
|
10 (5, 24)
|
0.103
|
Hospital length of stay(days)
|
19 (12, 32)
|
17 (10, 29)
|
22 (13, 34)
|
0.055
|
Mortality, n (%)
|
77 (34.2)
|
36 (32.4)
|
41 (36.0)
|
0.577
|
Data are mean ± SD, median (IQR) or n (%). P values comparing Direct and Indirect ARDS groups were from a two-sample t-test, Mann- Whitney U test, or χ² test. P < 0.05 was considered statistically significant.
﹡χ² test comparing Direct and Indirect ARDS groups.
﹟χ² test comparing all subcategories.
Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation, ARDS, acute respiratory disease syndrome, BMI, body mass index, DVT, deep venous thrombosis, FiO2, fraction of inspired oxygen, ICU, intensive care unit, IQR, interquartile range, mild, 200 mmHg<PaO2/FiO2 ≤ 300 mmHg, moderate, 100 mmHg<PaO2/FiO2 ≤ 200 mmHg, PaO2, partial pressure of arterial oxygen, SD, standard deviation, severe, PaO2/FiO2 ≤ 100 mmHg, SOFA, Sequential Organ Failure Assessment.
Table 2. Demographic and Clinical Characteristics of DVT Vs Non-DVT Patients in Overall ARDS Cohort
Characteristic
|
Total
|
DVT
|
Non-DVT
|
P value
|
|
(N = 225)
|
(n = 90)
|
(n = 135)
|
|
Age (years)
|
66 ± 17
|
70 ± 13
|
63 ± 18
|
< 0.001
|
Male, n (%)
|
144 (64.0)
|
52 (57.8)
|
92 (68.1)
|
0.112
|
BMI
|
24.1 (21.6, 26.8)
|
24.0 (20.8, 26.0)
|
24.2 (22.0, 27.2)
|
0.146
|
Bedridden time (days)
|
8 (4, 15)
|
10 (5, 18)
|
7 (4, 15)
|
0.216
|
Caprini score
|
7 (5, 9)
|
7 (5, 10)
|
7 (5, 9)
|
0.135
|
Padua prediction score
|
6 (5, 6)
|
6 (5, 8)
|
5 (5, 6)
|
0.023
|
APACHE II score
|
23 (19, 28)
|
24 (20, 28)
|
23 (18, 29)
|
0.596
|
SOFA score
|
8 (5, 10)
|
7 (5, 9)
|
8 (5, 11)
|
0.622
|
Laboratory data
|
White blood cells (×109/L)
|
16.9 (12.0, 21.4)
|
16.5 (13.4, 21.0)
|
17.1 (11.6, 22.6)
|
0.733
|
Neutrophils (×109/L)
|
14.5 (10.4, 19.7)
|
14.7 (11.4, 19.3)
|
14.4 (9.9, 20.1)
|
0.709
|
Platelets (×109/L)
|
183.0 (101.0, 253.5)
|
196.5 (124.3, 263.3)
|
172.0 (84.0, 253.0)
|
0.141
|
C-reactive protein(mg/L)
|
120.0 (89.4, 120.0)
|
120.0 (82.0, 120.0)
|
120.0 (92.5, 120.0)
|
0.471
|
Procalcitonin (ng/mL)
|
5.6 (2.0, 16.2)
|
12.7 (3.4, 21.5)
|
3.5 (1.5, 10.3)
|
< 0.001
|
Serum creatinine(μmol/L)
|
116.7 (66.6, 209.5)
|
95.1 (58.8, 165.5)
|
125.6 (70.6, 250.3)
|
0.007
|
D-dimer (μg/ml)
|
1.9 (0.9, 3.8)
|
2.1 (0.9, 5.0)
|
1.8 (0.9, 3.3)
|
0.070
|
PaO2 /FiO2
|
158 (103, 199)
|
137 (87, 179)
|
172 (116, 209)
|
0.002﹡
|
Mild, n (%)
|
54 (24.0)
|
14 (15.6)
|
40 (29.6)
|
0.026﹟
|
Moderate, n (%)
|
116 (51.6)
|
48 (53.3)
|
68 (50.4)
|
|
Severe, n (%)
|
55 (24.4)
|
28 (31.1)
|
27 (20.0)
|
|
Treatments
|
Glucocorticoid therapy, n (%)
|
51 (22.7)
|
22 (24.4)
|
29 (21.5)
|
0.603
|
Immunoglobulin, n (%)
|
5 (2.2)
|
2 (2.2)
|
3 (2.2)
|
1.000
|
Sedative therapy, n (%)
|
96 (42.7)
|
50 (55.6)
|
46 (34.1)
|
0.001
|
Vasoactive agent therapy, n (%)
|
55 (24.4)
|
25 (27.8)
|
30 (22.2)
|
0.342
|
CRRT, n (%)
|
33 (14.7)
|
10 (11.1)
|
23 (17.0)
|
0.218
|
CVC, n (%)
|
125 (55.6)
|
55 (61.1)
|
70 (51.9)
|
0.171
|
IMV, n (%)
|
122 (54.2)
|
66 (73.3)
|
56 (41.5)
|
< 0.001
|
Length of IMV (days)
|
3 (2, 7)
|
3 (2, 6)
|
3 (2, 8)
|
0.543
|
Length of IMV ≥ 3 days, n (%)
|
80 (65.6)
|
43 (65.2)
|
37 (66.1)
|
0.915
|
VTE prophylaxis, n (%)
|
135 (60.0)
|
50 (55.6)
|
85 (63.0)
|
0.267
|
LMWH, n (%)
|
108 (48.0)
|
39 (43.3)
|
69 (51.1)
|
0.253
|
LMWH + physical prophylaxis, n (%)
|
75 (33.5)
|
29 (32.6)
|
46 (34.1)
|
0.817
|
Physical prophylaxis only, n (%)
|
23 (10.3)
|
9 (10.1)
|
14 (10.4)
|
0.950
|
ICU length of stay(days)
|
11 (6, 24)
|
12 (5, 24)
|
11 (6, 26)
|
0.563
|
Hospital length of stay(days)
|
19 (12, 32)
|
20 (11, 32)
|
19 (12, 31)
|
0.816
|
Mortality, n (%)
|
77 (34.2)
|
45 (50.0)
|
32 (23.7)
|
< 0.001
|
Data are presented as mean ± SD, median (IQR), or n (%). P values comparing DVT and non-DVT groups were from a two-sample t-test, Mann-Whitney U test, χ² test, or Fisher exact test. P < 0.05 was considered statistically significant.
﹡ χ² test comparing DVT and non-DVT groups.
﹟ χ² test comparing all subcategories.
Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation, ARDS, acute respiratory disease syndrome, BMI, body mass index, CRRT, continuous renal replacement therapy, CVC, central venous catheterization, DVT, deep venous thrombosis, FiO2, fraction of inspired oxygen, ICU, intensive care unit, IMV, invasive mechanical ventilation, IQR, interquartile range, LMWH, low molecular weight heparin, mild, 200 mmHg<PaO2/FiO2 ≤ 300 mmHg, moderate, 100 mmHg<PaO2/FiO2 ≤ 200 mmHg, PaO2, partial pressure of arterial oxygen, SD, standard deviation, severe, PaO2/FiO2 ≤ 100 mmHg, SOFA, Sequential Organ Failure Assessment, VTE, venous thromboembolism.
Table 3. Echocardiographic Findings of DVT Vs Non-DVT Patients in Overall ARDS Cohort
Variables
|
Total
|
DVT
|
Non-DVT
|
P value
|
LA diameter (mm)
|
48 (43, 53)
|
47 (42, 53)
|
48 (43, 52)
|
0.764
|
LVESVI (mL/m2)
|
46 (43, 49)
|
46 (42, 48)
|
47 (44, 49)
|
0.041
|
LVEDVI (mL/m2)
|
29 (27, 32)
|
29 (26, 31)
|
30 (27, 32)
|
0.107
|
Simpson biplane EF (%)
|
66 (62, 70)
|
67 (62, 70)
|
66 (61, 70)
|
0.513
|
RA diameter (mm)
|
45 (41, 48)
|
45 (41, 48)
|
44 (40, 48)
|
0.236
|
RV diameter (mm)
|
30 (26, 32)
|
30 (27, 32)
|
29 (26, 32)
|
0.839
|
PA diameter (mm)
|
23 (21, 25)
|
23 (22, 25)
|
23 (21, 25)
|
0.933
|
PASP (mmHg)
|
40 (36, 48)
|
43 (38, 60)
|
38 (35, 46)
|
0.007
|
PAH, n (%)
|
55 (25.6)
|
25 (29.1)
|
30 (23.3)
|
0.338
|
Pericardial effusion
|
12 (5.6)
|
4 (4.7)
|
8 (6.2)
|
0.628
|
Tricuspid regurgitation
|
86 (40.0)
|
38 (44.2)
|
48 (37.2)
|
0.306
|
Data are presented as median (IQR) or n (%). P values comparing DVT and non-DVT were from Mann-Whitney U test, or χ² test. P<0.05 was considered statistically significant.
Abbreviations: ARDS, acute respiratory disease syndrome, DVT, deep vein thrombosis, EF, ejection fraction, LA, left atrial, LVEDVI, left ventricular end-diastolic volume index, LVESVI, left ventricular end-systolic volume index, PA, pulmonary artery, PAH, pulmonary artery hypertension, PASP, pulmonary artery systolic pressure, RA, right atrial, RV, right ventricular.
Table 4. Demographic and Clinical Characteristics of DVT Vs Non-DVT Patients in Direct and Indirect ARDS Cohorts
Characteristics
|
Direct ARDS (n = 111)
|
Indirect ARDS (n = 114)
|
DVT
(n = 44)
|
Non-DVT
(n = 67)
|
P
Value
|
DVT
(n = 46)
|
Non-DVT
(n = 68)
|
P
value
|
Age (years)
|
68 ± 11
|
62 ± 17
|
0.015
|
72 ± 15
|
64 ± 19
|
0.009
|
Male, n (%)
|
32 (72.7)
|
52 (77.6)
|
0.557
|
20 (43.5)
|
40 (58.8)
|
0.107
|
BMI
|
23.5 (20.6, 25.2)
|
24.2 (22.2, 27.2)
|
0.076
|
24.5 (21.3, 26.8)
|
24.0 (22.0, 27.3)
|
0.716
|
Bedridden time (days)
|
9 (6, 17)
|
9 (5, 15)
|
0.431
|
10 (4, 19)
|
7 (4, 14)
|
0.356
|
Caprini score
|
7 (5, 8)
|
7 (5, 9)
|
0.891
|
9 (6, 11)
|
7 (5,10)
|
0.021
|
Padua prediction score
|
5 (5, 6)
|
5 (5, 6)
|
0.689
|
7 (5, 8)
|
6 (4, 7)
|
0.008
|
APACHE II score
|
22 (17, 26)
|
21 (16, 27)
|
0.568
|
25 (21, 30)
|
25 (19, 32)
|
0.913
|
SOFA score
|
6 (5, 9)
|
6 (4, 10)
|
0.780
|
9 (7, 10)
|
9 (6,11)
|
0.772
|
Laboratory data
|
White blood cells (×109/L)
|
14.5 (10.0, 18.3)
|
14.1 (10.2, 20.7)
|
0.921
|
18.4 (15.0, 21.5)
|
18.1 (13.1, 24.2)
|
0.630
|
Neutrophils (×109/L)
|
12.8 (9.1, 16.8)
|
12.8 (8.9, 18.0)
|
0.935
|
16.1 (13.3, 19.8)
|
16.1 (11.0, 21.8)
|
0.669
|
Platelets (×109/L)
|
193.5
(155.3, 279.0)
|
181.0
(108.0, 257.0)
|
0.301
|
202.0
(84.3, 246.5)
|
148.5
(70.8, 234.0)
|
0.267
|
C-reactive protein (mg/L)
|
120.0
(82, 120.0)
|
120.0
(89.0,120.0)
|
0.490
|
120.0
(86.8, 120.0)
|
120.0
(94.4, 120.0)
|
0.758
|
Procalcitonin (ng/mL)
|
8.3 (2.6, 17.6)
|
2.6 (1.1, 9.6)
|
0.002
|
15.0 (4.9, 25.0)
|
4.9 (2.6, 13.5)
|
0.001
|
Serum creatinine (μmol/L)
|
77.3
(56.2, 122.4)
|
119.0
(70.6, 225.1)
|
0.003
|
135.5
(67.3, 208.8)
|
140.7
(70.0, 275.7)
|
0.377
|
D-dimer (μg/ml)
|
1.8 (0.7, 3.2)
|
1.2 (0.6, 2.1)
|
0.211
|
3.2 (1.6, 7.3)
|
2.1 (1.3, 4.7)
|
0.123
|
PaO2/FiO2
|
111 (71, 176)
|
150 (86, 203)
|
0.035﹡
|
152 (117, 184)
|
179 (140, 217)
|
0.017﹡
|
Mild, n (%)
|
5 (11.4)
|
17 (25.4)
|
0.062﹟
|
9 (19.6)
|
23 (33.8)
|
0.249﹟
|
Moderate, n (%)
|
18 (40.9)
|
31 (46.3)
|
|
30 (65.2)
|
37 (54.4)
|
|
Severe, n (%)
|
21 (47.7)
|
19 (28.4)
|
|
7 (15.2)
|
8 (11.8)
|
|
Treatments
|
Glucocorticoid therapy, n (%)
|
16 (36.4)
|
15 (22.4)
|
0.108
|
6 (13.0)
|
14 (20.6)
|
0.299
|
Immunoglobulin, n (%)
|
1 (2.3)
|
2 (3.0)
|
1.000
|
1 (2.2)
|
1 (1.5)
|
1.000
|
Sedative therapy, n (%)
|
25 (56.8)
|
25 (37.3)
|
0.043
|
25 (54.3)
|
21 (30.9)
|
0.012
|
Vasoactive agent therapy, n (%)
|
10 (22.7)
|
12 (17.9)
|
0.533
|
15 (32.6)
|
18 (26.5)
|
0.478
|
CRRT, n (%)
|
3 (6.8)
|
9 (13.4)
|
0.432
|
7 (15.2)
|
14 (20.6)
|
0.468
|
CVC, n (%)
|
19 (43.2)
|
26 (38.8)
|
0.646
|
36 (78.3)
|
44 (64.7)
|
0.121
|
IMV, n (%)
|
34 (77.3)
|
31 (46.3)
|
0.001
|
32 (69.6)
|
25 (36.8)
|
0.001
|
Length of IMV (days)
|
3 (2, 6)
|
3 (2, 10)
|
0.646
|
3 (2, 7)
|
3 (2, 8)
|
0.586
|
Length of IMV ≥ 3 days, n (%)
|
21 (61.8)
|
19 (61.3)
|
0.969
|
22 (68.8)
|
18 (72.0)
|
0.790
|
Mortality, n (%)
|
21 (47.7)
|
15 (22.4)
|
0.005
|
24 (52.2)
|
17 (25.0)
|
0.003
|
Data are presented as mean ± SD, median (IQR), or n (%). P values comparing DVT and non-DVT groups were from a two-sample t-test, Mann-Whitney U test, χ² test, or Fisher exact test. P < 0.05 was considered statistically significant.
﹡ χ² test comparing DVT and non-DVT groups.
﹟ χ² test comparing all subcategories.
Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation, ARDS, acute respiratory disease syndrome, BMI, body mass index, CRRT, continuous renal replacement therapy, CVC, central venous catheterization, DVT, deep venous thrombosis, FiO2, fraction of inspired oxygen, ICU, intensive care unit, IMV, invasive mechanical ventilation, IQR, interquartile range, LMWH, low molecular weight heparin, mild, 200 mmHg<PaO2/FiO2 ≤ 300 mmHg, moderate, 100 mmHg<PaO2/FiO2 ≤ 200 mmHg, PaO2, partial pressure of arterial oxygen, SD, standard deviation, severe, PaO2/FiO2 ≤ 100 mmHg, SOFA, Sequential Organ Failure Assessment, VTE, venous thromboembolism.
Table 5. Independent Predictors of Deep Vein Thrombosis in Patients with Direct and Indirect Acute Respiratory Distress Syndrome
Characteristics
|
Total ARDS (N=225)
|
Direct ARDS (n=111)
|
Indirect ARDS (n=114)
|
P Value for Interaction
With ARDS Type
|
Adjusted OR (95% CI)
|
P value
|
Adjusted OR (95% CI)
|
P value
|
Adjusted OR
(95% CI)
|
P value
|
Age
(per 10 years)
|
1.422 (1.147-1.763)
|
0.001
|
1.504 (1.0 25 - 2.207)
|
0.037
|
1.410 (1.070 - 1.856)
|
0.015
|
0.030
|
Serum creatinine (per 10 μmol/L)
|
0.939 (0.908 - 0.970)
|
< 0.001
|
0.857 (0.789 - 0.930)
|
< 0.001
|
0.971 (0.936 - 1.008)
|
0.120
|
0.006
|
Procalcitonin (ng/mL)
|
1.033 (0.997 - 1.070)
|
0.071
|
1.035 (0.975 - 1.099)
|
0.264
|
1.035 (0.989 -1.084)
|
0.134
|
|
D-dimer (μg/ml)
|
1.065 (0.985 - 1.151)
|
0.114
|
1.059 (0.852 - 1.317)
|
0.606
|
1.056 (0.971 - 1.149)
|
0.205
|
|
PaO2/FiO2
|
0.996 (0.990 - 1.002)
|
0.223
|
0.996 (0.986 - 1.006)
|
0.453
|
0.995 (0.987 - 1.004)
|
0.295
|
|
IMV
|
3.168 (1.579 - 6.356)
|
0.001
|
5.272 (1.536 - 18.100)
|
0.008
|
2.787 (1.144 - 6.792)
|
0.024
|
|
Multivariable logistic regression was performed in the overall ARDS cohort and then in the direct ARDS and indirect ARDS groups separately. The interactions of ARDS type (direct or indirect) with age, serum creatinine level, level of procalcitonin, level of D-dimer, PaO2/FiO2, and IMV were included in the regression analysis.
Abbreviations: ARDS, acute respiratory disease syndrome, CI, confidence interval, DVT, deep venous thrombosis, FiO2, fraction of inspired oxygen, IMV, invasive mechanical ventilation, OR, odds ratio, PaO2, partial pressure of arterial oxygen.