A risk tertiles model for predicting mortality in patients with acute respiratory distress syndrome: age, plateau pressure, and P(aO(2))/F(IO(2)) at ARDS onset can predict mortality.

Abstract:

BACKGROUND:Predicting mortality has become a necessary step for selecting patients for clinical trials and defining outcomes. We examined whether stratification by tertiles of respiratory and ventilatory variables at the onset of acute respiratory distress syndrome (ARDS) identifies patients with different risks of death in the intensive care unit. METHODS:We performed a secondary analysis of data from 220 patients included in 2 multicenter prospective independent trials of ARDS patients mechanically ventilated with a lung-protective strategy. Using demographic, pulmonary, and ventilation data collected at ARDS onset, we derived and validated a simple prediction model based on a population-based stratification of variable values into low, middle, and high tertiles. The derivation cohort included 170 patients (all from one trial) and the validation cohort included 50 patients (all from a second trial). RESULTS:Tertile distribution for age, plateau airway pressure (P(plat)), and P(aO(2))/F(IO(2)) at ARDS onset identified subgroups with different mortalities, particularly for the highest-risk tertiles: age (> 62 years), P(plat) (> 29 cm H(2)O), and P(aO(2))/F(IO(2)) (< 112 mm Hg). Risk was defined by the number of coexisting high-risk tertiles: patients with no high-risk tertiles had a mortality of 12%, whereas patients with 3 high-risk tertiles had 90% mortality (P < .001). CONCLUSIONS:A prediction model based on tertiles of patient age, P(plat), and P(aO(2))/F(IO(2)) at the time the patient meets ARDS criteria identifies patients with the lowest and highest risk of intensive care unit death.

journal_name

Respir Care

journal_title

Respiratory care

authors

Villar J,Pérez-Méndez L,Basaldúa S,Blanco J,Aguilar G,Toral D,Zavala E,Romera MA,González-Díaz G,Nogal FD,Santos-Bouza A,Ramos L,Macías S,Kacmarek RM,Hospitales Españoles Para el Estudio de la Lesión Pulmonar (HELP) Network*.

doi

10.4187/respcare.00811

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

420-8

issue

4

eissn

0020-1324

issn

1943-3654

pii

rc00811r3villar

journal_volume

56

pub_type

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