Jianfeng Xie1, Ling Liu1, Yi Yang1, Wenkui Yu2, Maoqin Li3, Kaijiang Yu4,5, Ruiqiang Zheng6, Jie Yan7, Xue Wang8, Guolong Cai9, Jianguo Li10, Qin Gu11, Hongsheng Zhao12, Xinwei Mu13, Xiaochun Ma14, Haibo Qiu1. 1. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China. 2. Department of Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China. 3. Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou 221009, China. 4. Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin 150040, China. 5. Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China. 6. Department of Critical Care Medicine, Subei People's Hospital, School of Medicine, Yangzhou University, Yangzhou 225001, China. 7. Department of Critical Care Medicine, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China. 8. Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China. 9. Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou 310013, China. 10. Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, 430071, Wuhan, China. 11. Department of Critical Care Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China. 12. Department of Critical Care Medicine, The First Affiliated Hospital of Nantong University, Nantong 226001, China. 13. Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China. 14. Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China.
Abstract
BACKGROUND: Early recognition of the risks of acute respiratory distress syndrome (ARDS) and prevention of the development of ARDS may be more effective in improving patient outcomes. We performed the present study to determine the ARDS risk factors in a Chinese population and validate a score to predict the development of ARDS. METHODS: This was an observational multicenter cohort study performed in 13 tertiary hospitals in China. Patients admitted into participating intensive care units (ICUs) from January 1 to January 31, 2012, and from January 1 to January 10, 2013, were enrolled in a retrospective derivation cohort and a prospective validation cohort, respectively. In the derivation cohort, the potential risk factors of ARDS were collected. The confirmed risk factors were determined with univariate and multivariate logistic regression analyses, and then the modified ARDS prediction score (MAPS) was established. We prospectively enrolled patients to verify the accuracy of MAPS. RESULTS: A total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 [95% confidence interval (CI), 0.758-0.859, P<0.001]. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717-0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728-0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046). CONCLUSIONS: The MAPS based on risk factors could help the clinician to predict patients who will develop ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666834.
BACKGROUND: Early recognition of the risks of acute respiratory distress syndrome (ARDS) and prevention of the development of ARDS may be more effective in improving patient outcomes. We performed the present study to determine the ARDS risk factors in a Chinese population and validate a score to predict the development of ARDS. METHODS: This was an observational multicenter cohort study performed in 13 tertiary hospitals in China. Patients admitted into participating intensive care units (ICUs) from January 1 to January 31, 2012, and from January 1 to January 10, 2013, were enrolled in a retrospective derivation cohort and a prospective validation cohort, respectively. In the derivation cohort, the potential risk factors of ARDS were collected. The confirmed risk factors were determined with univariate and multivariate logistic regression analyses, and then the modified ARDS prediction score (MAPS) was established. We prospectively enrolled patients to verify the accuracy of MAPS. RESULTS: A total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 [95% confidence interval (CI), 0.758-0.859, P<0.001]. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717-0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728-0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046). CONCLUSIONS: The MAPS based on risk factors could help the clinician to predict patients who will develop ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666834.
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