[Criteria suitable for diagnosis of acute respiratory distress syndrome/multiple organ dysfunction syndrome at moderately high altitude area].
OBJECTIVE
To compare the diagnostic parameters of acute respiratory distress syndrome/multiple organ dysfunction syndrome (ARDS/MODS) at high altitude (H-ARDS/MODS) with that on plain, and to establish a more practical diagnostic criterion of H-ARDS/MODS.


METHODS
Five hundred and five cases fulfilled the criteria for the diagnosis of ARDS/MODS were divided into three groups according to the altitude of their habitation: control group including inhabitants (<430 m) on plain (CG, n=113), moderate high altitude group 1 inhabitants at the altitude of 1,517 m (H1G, n=314), moderate high altitude group 2 inhabitants at the altitude of 2,261 m to 2,400 m (H2G, n=78). The ARDS/MODS scores of the three groups were made according to the diagnostic criteria of Lushan conference, Marshall(1995) and Lanzhou criteria drafted by the authors respectively to set up three data analyzing models, followed by plotting of receiver operating characteristic curves (ROC curve) and calculation of the Yordon Index and the optimum cutoff points of the parameters,in order to study the accuracy of the three diagnostic criteria in predicting the outcome of the patients suffering from ARDS/MODS.


RESULTS
In CG group, the differences were not significant in area of ROC, the maximal Yordon Index, the optimum cutoff points and the sensitivity and the specificity for three criteria; but the differences were significant for the three criteria in H1G group. Further investigation in comparing the ROC values of lung, brain, heart and kidney, the Lanzhou criteria were more advantageous in the high altitude than the other criteria.


CONCLUSIONS
(1)The current diagnostic criteria of ARDS/MODS are not suitable for the diagnosis of these syndromes in moderately high or high altitude areas. It is necessary to revise the diagnostic criteria of H-ARDS/MODS. (2)One thousand five hundred and seventeen meters in altitude might be considered to be an important borderline, above with the diagnostic criteria of ARDS/MODS for patients inhabiting on plain could not be suitably applied to those living above this level.
Zhang
Shi-fan
SF
Lanzhou General Hospital of Lanzhou Command, Lanzhou 730050, Gansu, China.
Zhang
De-hai
DH
Liu
Hui-ping
HP
Gao
Wei
W
Luo
Xiao-hong
XH
Wu
Jian-ying
JY
Lin
Shu-xin
SX
Liu
Chuan-lan
CL
Zhang
Xian-ying
XY
Chen
Tian-duo
TD
D000531:Altitude; D006801:Humans; D009102:Multiple Organ Failure / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012128:Respiratory Distress Syndrome / Q000175:diagnosis*; D012189:Retrospective Studies; D012720:Severity of Illness Index