Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review

doi:10.12114/j.issn.1007-9572.2024.0109

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (12): 1527-1537.DOI: 10.12114/j.issn.1007-9572.2024.0109

• Evidence-based Medicine • Previous Articles Next Articles

Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review

1. Department of Respiratory Diseases, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450003, China
2. The First Clinical Medical School, Henan University of Chinese Medicine, Zhengzhou 450003, China
3. Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P.R. China/Henan Key Laboratory of Chinese Medicine for Respiratory Diseases, Henan University of Chinese Medicine, Zhengzhou 450046, China

Received:2024-04-18 Revised:2024-07-26 Published:2025-04-20 Online:2025-02-06
Contact: FENG Zhenzhen

急性呼吸窘迫综合征患者并发急性肾损伤危险因素的系统评价

1．450003　河南省郑州市，河南中医药大学第一附属医院呼吸科
2．450003　河南省郑州市，河南中医药大学第一临床医学院
3．450046　河南省郑州市，河南中医药大学呼吸疾病中医药防治省部共建协同创新中心　河南省中医药防治呼吸病重点实验室

通讯作者: 冯贞贞
作者简介:
作者贡献：
王晓雨负责文章的构思与设计、研究资料的收集与整理、论文撰写；冯贞贞负责文章的质量控制与审查，对文章整体负责，监督管理；王军、郭小川负责数据的收集与整理、统计学处理指导；李建生负责论文最终版本审阅修订。
基金资助:
中医药传承与创新"百千万"人才工程—岐黄工程首席科学家项目(2021-7); 呼吸疾病中医药防治国家中医药传承创新团队(ZYYCXTD-C-202206); 河南省中医药科学研究专项课题(2022JDZX102)

Abstract

Abstract:

Background

Acute kidney injury (AKI) is one of the most common complications of acute respiratory distress syndrome (ARDS) and significantly increases the mortality rate of ARDS patients. Currently, the clinical understanding of ARDS complicated with AKI, effective prevention and treatment measures are not enough. Exploring the possible predictors is significant for early evaluation and effective intervention measures to reduce the incidence and mortality of AKI in ARDS.

Objective

To systematically evaluate the risk factors of AKI in ARDS.

Methods

PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed were searched for literatures on risk factors of AKI in ARDS from inception to December 2023. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of included literatures. RevMan 5.3 software was used for Meta-analysis.

Results

A total of 17 studies involving 6 160 patients were included. Meta-analysis demonstrated that: being older (OR=1.02, 95%CI=1.00-1.03, P=0.007), higher Sequential Organ Failure Assessment (SOFA) scores (OR=1.17, 95%CI=1.05-1.30, P=0.004), diabetes (OR=1.40, 95%CI=1.09-1.80, P=0.008), hypertension (OR=1.56, 95%CI=1.26-1.93, P<0.001), atrial fibrillation (OR=1.76, 95%CI=1.09-2.85, P=0.020), chronic kidney disease (OR=10.31, 95%CI=3.30-32.19, P<0.001), higher neutrophil to lymphocyte ratio (NLR) (OR=1.02, 95%CI=1.00-1.05, P=0.030), higher angiopoietin 2 (Ang-2) (OR=1.84, 95%CI=1.73-1.95, P<0.001), aspartate aminotransferase (AST) >40 U/L (OR=2.27, 95%CI=1.56-3.31, P<0.001), lower arterial blood pH (OR=0.83, 95%CI=0.75-0.92, P=0.000 6), lower glomerular filtration rate (GFR) (OR=0.92, 95%CI=0.75-0.99, P=0.020), mechanical ventilation (OR=2.53, 95%CI=1.96-3.26, P<0.001) and extracorporeal membrane oxygenation (ECMO) (OR=1.81, 95%CI=1.43-2.28, P<0.001) were risk factors for AKI in ARDS. However, gender (OR=1.17, 95%CI=0.82-1.67, P=0.390), BMI (OR=1.27, 95%CI=0.77-2.09, P=0.350), obesity (OR=5.88, 95%CI=0.51-68.28, P=0.160), Acute Physiology and Chronic Health Evaluation Ⅱ scores (OR=1.20, 95%CI=0.99-1.46, P=0.060), heart failure (OR=4.49, 95%CI=0.58-34.70, P=0.150), disturbance of consciousness (OR=1.83, 95%CI=0.88-3.84, P=0.110), pleural effusion (OR=1.16, 95%CI=0.81-1.65, P=0.410), oxygenation index (OR=4.30, 95%CI=0.69-26.77, P=0.120), procalcitonin (OR=1.08, 95%CI=0.95-1.23, P=0.230), white blood cell count (OR=1.56, 95%CI=0.51-4.80, P=0.440) and plasma albumin (OR=1.07, 95%CI=0.97-1.17, P=0.170) were not related to AKI in ARDS.

Conclusion

The risk factors of AKI in ARDS involve many aspects, including general factors (being older), overall assessment (high SOFA scores), disease factors (combined with diabetes, hypertension, atrial fibrillation and chronic kidney disease), laboratory indicators (higher NLR, higher Ang-2, AST>40 U/L, lower arterial blood pH and GFR), and treatment (mechanical ventilation, ECMO). Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by more high-quality studies in the future.

Key words: Acute respiratory distress syndrome, Acute kidney injury, Risk factors, Systematic reviews, Meta-analysis

摘要：

背景

急性肾损伤（AKI）是急性呼吸窘迫综合征（ARDS）常见的并发症之一，显著增加了ARDS患者的死亡率。目前临床对于ARDS并发AKI的认识及有效防治措施尚不足，探索可能的预测因子对于早期评估并及时采取有效干预措施，以降低ARDS患者AKI的发生率及死亡率具有重要意义。

目的

系统评价ARDS患者并发AKI的危险因素。

方法

计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网（CNKI）、万方数据知识服务平台（Wanfang Data）、维普网（VIP）、中国生物医学文献服务系统（SinoMed）数据库中ARDS患者并发AKI危险因素的相关文献，检索时间从建库至2023年12月。由2名研究者按照纳入和排除标准独立进行文献筛选、资料提取和质量评价后，采用RevMan 5.3软件进行Meta分析。

结果

共纳入17篇文献，包含6 160例患者。Meta分析结果显示：年龄增长（OR=1.02，95%CI=1.00~1.03，P=0.007）、序贯器官衰竭（SOFA）评分较高（OR=1.17，95%CI=1.05~1.30，P=0.004），合并糖尿病（OR=1.40，95%CI=1.09~1.80，P=0.008）、高血压（OR=1.56，95%CI=1.26~1.93，P<0.001）、心房颤动（OR=1.76，95%CI=1.09~2.85，P=0.020）、慢性肾病（OR=10.31，95%CI=3.30~32.19，P<0.001），中性粒细胞与淋巴细胞比值（NLR）（OR=1.02，95%CI=1.00~1.05，P=0.030）、血管生成素2（Ang-2）（OR=1.84，95%CI=1.73~1.95，P<0.001）水平升高，天冬氨酸氨基转移酶（AST）>40 U/L（OR=2.27，95%CI=1.56~3.31，P<0.001），动脉血pH值降低（OR=0.83，95%CI=0.75~0.92，P=0.000 6）、肾小球滤过率（GFR）降低（OR=0.92，95%CI=0.86~0.99，P=0.020），机械通气（OR=2.53，95%CI=1.96~3.26，P<0.001）、体外膜肺氧合（ECMO）（OR=1.81，95%CI=1.43~2.28，P<0.001）治疗是ARDS患者并发AKI的危险因素。而性别（OR=1.17，95%CI=0.82~1.67，P=0.390）、BMI（OR=1.27，95%CI=0.77~2.09，P=0.350）、肥胖（OR=5.88，95%CI=0.51~68.28，P=0.160）、急性生理与慢性健康评分（OR=1.20，95%CI=0.99~1.46，P=0.060）、心力衰竭（OR=4.49，95%CI=0.58~34.70，P=0.150）、意识障碍（OR=1.83，95%CI=0.88~3.84，P=0.110）、胸腔积液（OR=1.16，95%CI=0.81~1.65，P=0.410）、氧合指数（OR=4.30，95%CI=0.69~26.77，P=0.120）、降钙素原（OR=1.08，95%CI=0.95~1.23，P=0.230）、白细胞计数（OR=1.56，95%CI=0.51~4.80，P=0.440）、血浆白蛋白（OR=1.07，95%CI=0.97~1.17，P=0.170）与ARDS患者并发AKI不相关。

结论

ARDS患者并发AKI的危险因素涉及多个方面，包括一般因素（年龄增长）、整体评估（SOFA评分高）、疾病因素（合并糖尿病、高血压、心房颤动、慢性肾病）、实验室指标（NLR、Ang-2水平升高，AST>40 U/L，动脉血pH值、GFR降低）以及治疗方面（机械通气、ECMO）。受纳入研究数量及质量局限，本结论仍需未来更多高质量研究加以验证。

关键词: 急性呼吸窘迫综合征, 急性肾损伤, 危险因素, 系统评价, Meta分析

CLC Number:

R 563.8 R 692.5

WANG Xiaoyu,FENG Zhenzhen,WANG Jun, et al. Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review[J]. Chinese General Practice, 2025, 28(12): 1527-1537. DOI: 10.12114/j.issn.1007-9572.2024.0109.
王晓雨,冯贞贞,王军等. 急性呼吸窘迫综合征患者并发急性肾损伤危险因素的系统评价[J]. 中国全科医学, 2025, 28(12): 1527-1537. DOI: 10.12114/j.issn.1007-9572.2024.0109.

Figures/Tables 6

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序号	检索策略
#1	Respiratory Distress Syndrome[MeSH Terms] OR Respiratory Distress Syndrome[Title/Abstract] OR Distress Syndrome，Respiratory[Title/Abstract] OR Distress Syndromes，Respiratory[Title/Abstract] OR Respiratory Distress Syndromes[Title/Abstract] OR Syndrome，Respiratory Distress[Title/Abstract] OR Shock Lung[Title/Abstract] OR Lung，Shock[Title/Abstract] OR Respiratory Distress Syndrome，Acute[Title/Abstract] OR Acute Respiratory Distress Syndrome[Title/Abstract] OR ARDS[Title/Abstract]
#2	Acute Kidney Injury[MeSH Terms] OR Acute Kidney Injury[Title/Abstract] OR Acute Kidney Injuries[Title/Abstract] OR Kidney Injuries，Acute[Title/Abstract] OR Kidney Injury，Acute[Title/Abstract] OR Acute Renal Injury[Title/Abstract] OR Acute Renal Injuries[Title/Abstract] OR Renal Injuries，Acute[Title/Abstract] OR Renal Injury，Acute[Title/Abstract] OR Renal Insufficiency，Acute[Title/Abstract] OR Acute Renal Insufficiencies[Title/Abstract] OR Renal Insufficiencies，Acute[Title/Abstract] OR Acute Renal Insufficiency[Title/Abstract] OR Kidney Insufficiency，Acute[Title/Abstract] OR Acute Kidney Insufficiencies[Title/Abstract] OR Kidney Insufficiencies，Acute[Title/Abstract] OR Acute Kidney Insufficiency[Title/Abstract] OR Kidney Failure，Acute[Title/Abstract] OR Acute Kidney Failures[Title/Abstract] OR Kidney Failures，Acute[Title/Abstract] OR Acute Renal Failure[Title/Abstract] OR Acute Renal Failures[Title/Abstract] OR Renal Failures，Acute[Title/Abstract] OR Renal Failure，Acute[Title/Abstract] OR Acute Kidney Failure[Title/Abstract]
#3	Risk Factors[MeSH Terms] OR Risk Factors[Title/Abstract] OR Factor，Risk[Title/Abstract] OR Risk Factor[Title/Abstract] OR Social Risk Factors[Title/Abstract] OR Factor，Social Risk[Title/Abstract] OR Factors，Social Risk[Title/Abstract] OR Risk Factor，Social[Title/Abstract] OR Risk Factors，Social[Title/Abstract] OR Social Risk Factor[Title/Abstract] OR Population at Risk[Title/Abstract] OR Populations at Risk[Title/Abstract] OR Risk Scores[Title/Abstract] OR Risk Score[Title/Abstract] OR Score，Risk[Title/Abstract] OR Risk Factor Scores[Title/Abstract] OR Risk Factor Score[Title/Abstract] OR Score，Risk Factor[Title/Abstract]
#4	#1 AND #2 AND #3

序号	检索策略
#1	Respiratory Distress Syndrome[MeSH Terms] OR Respiratory Distress Syndrome[Title/Abstract] OR Distress Syndrome，Respiratory[Title/Abstract] OR Distress Syndromes，Respiratory[Title/Abstract] OR Respiratory Distress Syndromes[Title/Abstract] OR Syndrome，Respiratory Distress[Title/Abstract] OR Shock Lung[Title/Abstract] OR Lung，Shock[Title/Abstract] OR Respiratory Distress Syndrome，Acute[Title/Abstract] OR Acute Respiratory Distress Syndrome[Title/Abstract] OR ARDS[Title/Abstract]
#2	Acute Kidney Injury[MeSH Terms] OR Acute Kidney Injury[Title/Abstract] OR Acute Kidney Injuries[Title/Abstract] OR Kidney Injuries，Acute[Title/Abstract] OR Kidney Injury，Acute[Title/Abstract] OR Acute Renal Injury[Title/Abstract] OR Acute Renal Injuries[Title/Abstract] OR Renal Injuries，Acute[Title/Abstract] OR Renal Injury，Acute[Title/Abstract] OR Renal Insufficiency，Acute[Title/Abstract] OR Acute Renal Insufficiencies[Title/Abstract] OR Renal Insufficiencies，Acute[Title/Abstract] OR Acute Renal Insufficiency[Title/Abstract] OR Kidney Insufficiency，Acute[Title/Abstract] OR Acute Kidney Insufficiencies[Title/Abstract] OR Kidney Insufficiencies，Acute[Title/Abstract] OR Acute Kidney Insufficiency[Title/Abstract] OR Kidney Failure，Acute[Title/Abstract] OR Acute Kidney Failures[Title/Abstract] OR Kidney Failures，Acute[Title/Abstract] OR Acute Renal Failure[Title/Abstract] OR Acute Renal Failures[Title/Abstract] OR Renal Failures，Acute[Title/Abstract] OR Renal Failure，Acute[Title/Abstract] OR Acute Kidney Failure[Title/Abstract]
#3	Risk Factors[MeSH Terms] OR Risk Factors[Title/Abstract] OR Factor，Risk[Title/Abstract] OR Risk Factor[Title/Abstract] OR Social Risk Factors[Title/Abstract] OR Factor，Social Risk[Title/Abstract] OR Factors，Social Risk[Title/Abstract] OR Risk Factor，Social[Title/Abstract] OR Risk Factors，Social[Title/Abstract] OR Social Risk Factor[Title/Abstract] OR Population at Risk[Title/Abstract] OR Populations at Risk[Title/Abstract] OR Risk Scores[Title/Abstract] OR Risk Score[Title/Abstract] OR Score，Risk[Title/Abstract] OR Risk Factor Scores[Title/Abstract] OR Risk Factor Score[Title/Abstract] OR Score，Risk Factor[Title/Abstract]
#4	#1 AND #2 AND #3

第一作者	发表年份（年）	国家	研究类型	样本量（例）	ARDS诊断标准	AKI诊断标准	AKI发生率（%）	危险因素
SOTO^[5]	2012	美国	前瞻性队列研究	751	柏林定义	RIFLE	61.9	④
CRUZ-LAGUNAS^[6]	2014	墨西哥	回顾性病例对照研究	32	柏林定义	AKIN	53.1	④
章兵^[7]	2018	中国	回顾性病例对照研究	86	柏林定义	KDIGO	32.6	⑨⑭㉓㉗
陈大伟^[14]	2018	中国	回顾性病例对照研究	837	柏林定义	KDIGO	53.3	②⑲㉓㉕
PANITCHOTE ^[15]	2019	美国	回顾性队列研究	357	柏林定义	KDIGO	68.3	①⑤⑦⑯
HAN^[16]	2019	中国	回顾性病例对照研究	501	柏林定义	KDIGO	29.5	⑦⑧⑩⑪⑬⑳㉚
SHEBL^[17]	2020	埃及	前瞻性队列研究	81	柏林定义	KDIGO	38.3	③⑤⑥
谢晓元^[18]	2020	中国	回顾性病例对照研究	105	柏林定义	KDIGO	55.2	⑥㉑
WANG^[19]	2021	中国	回顾性病例对照研究	275	柏林定义	KDIGO	49.5	①②⑤⑫⑰㉒
徐慈^[20]	2021	中国	前瞻性病例对照研究	210	柏林定义	KDIGO	69.4	①⑧⑱㉑
濮雪华^[21]	2021	中国	回顾性病例对照研究	120	柏林定义	KDIGO	47.5	⑩⑮⑯
韩红^[22]	2021	中国	回顾性病例对照研究	432	柏林定义	KDIGO	29.9	⑦⑧⑩⑪⑬⑰⑳㉒㉓
CAI^[23]	2022	中国	回顾性病例对照研究	193	柏林定义	KDIGO	53.2	⑤⑮㉘
CUI^[24]	2022	中国	前瞻性病例对照研究	311	柏林定义	KDIGO	51.8	①⑥⑦⑫㉔㉙
叶剑滨^[25]	2022	中国	回顾性病例对照研究	80	柏林定义	KDIGO	30	⑨⑭⑱㉓㉖
张宾^[26]	2023	中国	回顾性病例对照研究	90	ARDS诊治指南	KDIGO	32.2	①⑭⑲㉓
MCNICHOLAS^[27]	2023	多国	前瞻性队列研究	1 699	柏林定义	KDIGO	20.9	①②③⑤⑦⑧㉔

第一作者	发表年份（年）	国家	研究类型	样本量（例）	ARDS诊断标准	AKI诊断标准	AKI发生率（%）	危险因素
SOTO^[5]	2012	美国	前瞻性队列研究	751	柏林定义	RIFLE	61.9	④
CRUZ-LAGUNAS^[6]	2014	墨西哥	回顾性病例对照研究	32	柏林定义	AKIN	53.1	④
章兵^[7]	2018	中国	回顾性病例对照研究	86	柏林定义	KDIGO	32.6	⑨⑭㉓㉗
陈大伟^[14]	2018	中国	回顾性病例对照研究	837	柏林定义	KDIGO	53.3	②⑲㉓㉕
PANITCHOTE ^[15]	2019	美国	回顾性队列研究	357	柏林定义	KDIGO	68.3	①⑤⑦⑯
HAN^[16]	2019	中国	回顾性病例对照研究	501	柏林定义	KDIGO	29.5	⑦⑧⑩⑪⑬⑳㉚
SHEBL^[17]	2020	埃及	前瞻性队列研究	81	柏林定义	KDIGO	38.3	③⑤⑥
谢晓元^[18]	2020	中国	回顾性病例对照研究	105	柏林定义	KDIGO	55.2	⑥㉑
WANG^[19]	2021	中国	回顾性病例对照研究	275	柏林定义	KDIGO	49.5	①②⑤⑫⑰㉒
徐慈^[20]	2021	中国	前瞻性病例对照研究	210	柏林定义	KDIGO	69.4	①⑧⑱㉑
濮雪华^[21]	2021	中国	回顾性病例对照研究	120	柏林定义	KDIGO	47.5	⑩⑮⑯
韩红^[22]	2021	中国	回顾性病例对照研究	432	柏林定义	KDIGO	29.9	⑦⑧⑩⑪⑬⑰⑳㉒㉓
CAI^[23]	2022	中国	回顾性病例对照研究	193	柏林定义	KDIGO	53.2	⑤⑮㉘
CUI^[24]	2022	中国	前瞻性病例对照研究	311	柏林定义	KDIGO	51.8	①⑥⑦⑫㉔㉙
叶剑滨^[25]	2022	中国	回顾性病例对照研究	80	柏林定义	KDIGO	30	⑨⑭⑱㉓㉖
张宾^[26]	2023	中国	回顾性病例对照研究	90	ARDS诊治指南	KDIGO	32.2	①⑭⑲㉓
MCNICHOLAS^[27]	2023	多国	前瞻性队列研究	1 699	柏林定义	KDIGO	20.9	①②③⑤⑦⑧㉔

纳入研究	研究对象选择				病例和对照的可比性	暴露因素测量			总分
纳入研究	病例确定是否恰当	病例的代表性	对照的选择	对照的确定	病例和对照的可比性	暴露因素的确定	病例和对照的暴露调查方法	无应答率	总分
CRUZ^[6]	1	0	0	1	2	0	1	1	6
章兵^[7]	1	0	0	1	2	1	1	1	7
陈大伟^[14]	1	1	0	1	2	1	1	1	8
HAN^[16]	1	1	0	1	2	0	1	1	7
谢晓元^[18]	1	0	0	1	2	0	1	1	6
WANG^[19]	1	1	0	1	2	1	1	1	8
徐慈^[20]	1	0	0	1	2	0	1	1	6
濮雪华^[21]	1	0	0	1	2	0	1	1	6
韩红^[22]	1	0	0	1	2	0	1	1	6
CAI^[23]	1	1	0	1	2	1	1	1	8
CUI^[24]	1	1	0	1	2	0	1	1	7
叶剑滨^[25]	1	0	0	1	2	0	1	1	6
张宾^[26]	1	0	0	1	2	0	1	1	6

Risk Factors for Acute Kidney Injury in Acute Respiratory Distress Syndrome: a Systematic Review

急性呼吸窘迫综合征患者并发急性肾损伤危险因素的系统评价

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纳入研究	研究对象选择				暴露组和非暴露组的可比性	暴露因素测量			总分
纳入研究	暴露组代表性	非暴露组的选择	暴露因素的确定	研究开始前无结局事件发生	暴露组和非暴露组的可比性	结局事件的评估	随访是否充分	随访完整性	总分
SOTO^[5]	1	1	1	1	2	1	1	1	9
PANITCHOTE^[15]	1	1	1	0	2	1	1	1	8
SHEBL^[17]	1	1	1	1	2	1	1	1	9
MCNICHOLAS^[27]	1	1	1	1	2	1	1	1	9

危险因素	纳入研究（项）	异质性检验		效应模型	OR值	95%CI	P值
危险因素	纳入研究（项）	I²值（%）	P值	效应模型	OR值	95%CI	P值
一般因素
年龄	6^{[15，19，20，24，26，27]}	71	0.004	随机	1.02	1.00~1.03	0.007
年龄（中国）	4^{[19，20，24，26]}	73	0.010	随机	1.04	1.00~1.09	0.040
男性	3^{[14，19，27]}	72	0.030	随机	1.17	0.82~1.67	0.390
男性（中国）	2^[14，19]	51	0.150	随机	1.35	0.86~2.13	0.190
BMI	2^[17，27]	88	0.003	随机	1.27	0.77~2.09	0.350
肥胖	2^[5，6]	56	0.130	随机	5.88	0.51~68.28	0.160
整体评估
SOFA评分	5^{[15，17，19，23，27]}	75	0.003	随机	1.17	1.05~1.30	0.004
SOFA评分（中国）	2^[19，23]	0	0.390	固定	1.09	1.01~1.18	0.030
APACHEⅡ评分	3^{[17，18，24]}	79	0.008	随机	1.20	0.99~1.46	0.060
APACHEⅡ评分（中国）	2^[18，24]	83	0.020	随机	1.28	0.81~2.02	0.290
疾病因素
糖尿病	5^{[15，16，22，24，27]}	51	0.080	随机	1.40	1.09~1.80	0.008
糖尿病（中国）	3^{[16，22，24]}	0	0.650	固定	1.81	1.26~2.59	0.001
高血压	4^{[16，20，22，27]}	75	0.007	随机	1.56	1.26~1.93	<0.001
高血压（中国）	3^{[16，20，22]}	0	0.970	固定	1.70	1.62~1.79	<0.001
心力衰竭	2^[7，25]	76	0.040	随机	4.49	0.58~34.70	0.150
意识障碍	3^{[16，21，22]}	84	0.002	随机	1.83	0.88~3.84	0.110
心房颤动	2^[16，22]	0	0.710	固定	1.76	1.09~2.85	0.020
慢性肾病	2^[19，24]	0	0.970	固定	10.31	3.30~32.19	<0.001
胸腔积液	2^[16，22]	0	0.750	固定	1.16	0.81~1.65	0.410
实验室指标
氧合指数	3^{[7，25，26]}	90	<0.001	随机	4.30	0.69~26.77	0.120
PCT	2^[21，23]	82	0.020	随机	1.08	0.95~1.23	0.230
动脉血pH值	2^[15，21]	0	0.390	固定	0.83	0.75~0.92	0.000 6
NLR	2^[19，22]	59	0.120	随机	1.02	1.00~1.05	0.030
Ang-2	2^[20，25]	41	0.190	固定	1.84	1.73~1.95	<0.001
WBC	2^[14，26]	69	0.070	随机	1.56	0.51~4.80	0.440
AST>40 U/L	2^[16，22]	0	0.650	固定	2.27	1.56~3.31	<0.001
GFR	2^[18，20]	0	0.530	固定	0.92	0.86~0.99	0.020
血浆白蛋白	2^[19，22]	83	0.020	随机	1.07	0.97~1.17	0.170
治疗因素
机械通气	5^{[7，14，22，25，26]}	44	0.130	固定	2.53	1.96~3.26	<0.001
ECMO	2^[24，27]	0	0.440	固定	1.81	1.43~2.28	<0.001

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