Jesús Villar1, Alfonso Ambrós, Juan Alfonso Soler, Domingo Martínez, Carlos Ferrando, Rosario Solano, Fernando Mosteiro, Jesús Blanco, Carmen Martín-Rodríguez, María Del Mar Fernández, Julia López, Francisco J Díaz-Domínguez, David Andaluz-Ojeda, Eleuterio Merayo, Lina Pérez-Méndez, Rosa Lidia Fernández, Robert M Kacmarek. 1. 1CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 2Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain. 3Intensive Care Unit, Hospital General de Ciudad Real, Ciudad Real, Spain. 4Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain. 5Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 6Post-Surgical Unit, Department of Anesthesia, Hospital Clínico de Valencia, Valencia, Spain. 7Intensive Care Unit, Hospital Virgen de la Luz, Cuenca, Spain. 8Intensive Care Unit, Hospital Universitario A Coruña, Coruña, Spain. 9Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. 10Intensive Care Unit, Hospital Universitario Mutua de Terrassa, Barcelona, Spain. 11Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 12Intensive Care Unit, Hospital General de León, León, Spain. 13Intensive Care Unit, Hospital Clínico de Valladolid, Valladolid, Spain. 14Intensive Care Unit, Hospital del Bierzo, Ponferrada, León, Spain. 15Research Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard University, Boston, MA.
Abstract
OBJECTIVES: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis. DESIGN: A prospective, multicenter, observational, descriptive, and validation study. SETTING: A network of multidisciplinary ICUs. PATIENTS: Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. CONCLUSIONS: A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.
OBJECTIVES: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndromepatients 24 hours after diagnosis. DESIGN: A prospective, multicenter, observational, descriptive, and validation study. SETTING: A network of multidisciplinary ICUs. PATIENTS: Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndromepatients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndromepatients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort. CONCLUSIONS: A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndromepatients with high probability.
Authors: Raquel S Santos; Pedro L Silva; Jose Rodolfo Rocco; Paolo Pelosi; Patricia Rieken Macêdo Rocco Journal: J Thorac Dis Date: 2016-08 Impact factor: 2.895
Authors: Zhiguo Zhao; Nancy Wickersham; Kirsten N Kangelaris; Addison K May; Gordon R Bernard; Michael A Matthay; Carolyn S Calfee; Tatsuki Koyama; Lorraine B Ware Journal: Intensive Care Med Date: 2017-06-07 Impact factor: 17.440
Authors: Emilia Apostolova; Amit Uppal; Jessica E Galarraga; Ioannis Koutroulis; Tim Tschampel; Tony Wang; Tom Velez Journal: AMIA Annu Symp Proc Date: 2020-03-04
Authors: L D Bos; L R Schouten; L A van Vught; M A Wiewel; D S Y Ong; O Cremer; A Artigas; I Martin-Loeches; A J Hoogendijk; T van der Poll; J Horn; N Juffermans; C S Calfee; M J Schultz Journal: Thorax Date: 2017-04-27 Impact factor: 9.139