Early predictive factors of survival in the acute respiratory distress syndrome - A multivariate analysis

被引:256
作者
Monchi, M [1 ]
Bellenfant, F [1 ]
Cariou, A [1 ]
Joly, LM [1 ]
Thebert, D [1 ]
Laurent, I [1 ]
Dhainaut, JF [1 ]
Brunet, F [1 ]
机构
[1] Hop Cochin, Med Intens Care Unit, Paris, France
关键词
D O I
10.1164/ajrccm.158.4.9802009
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and Pa-O2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/Pa-O2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.95 respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.
引用
收藏
页码:1076 / 1081
页数:6
相关论文
共 34 条
  • [1] ASHBAUGH DG, 1967, LANCET, V2, P319
  • [2] REPORT OF THE AMERICAN-EUROPEAN CONSENSUS CONFERENCE ON ARDS - DEFINITIONS, MECHANISMS, RELEVANT OUTCOMES AND CLINICAL-TRIAL COORDINATION
    BERNARD, GR
    ARTIGAS, A
    BRIGHAM, KL
    CARLET, J
    FALKE, K
    HUDSON, L
    LAMY, M
    LEGALL, JR
    MORRIS, A
    SPRAGG, R
    DHAINAUT, JF
    MATTHAY, M
    MANCEBO, J
    MEYRICK, B
    PAYEN, D
    PERRET, C
    FOWLER, AA
    SCHALLER, MD
    VANASBECK, BS
    COCHIN, B
    LANKEN, PN
    LEEPER, KV
    MARINI, J
    MURRAY, JF
    OPPENHEIMER, L
    PESENTI, A
    REID, L
    RINALDO, J
    VILLAR, J
    Hyers, T
    Knaus, W
    Matthay, R
    Pinsky, M
    Bone, RC
    Bosken, C
    Johanson, WG
    Lewandowski, K
    Repine, J
    Rodriguez-Roisin, R
    Roussos, C
    [J]. INTENSIVE CARE MEDICINE, 1994, 20 (03) : 225 - 232
  • [3] AN EARLY TEST OF SURVIVAL IN PATIENTS WITH THE ADULT RESPIRATORY-DISTRESS SYNDROME - THE PAO2/FLO2 RATIO AND ITS DIFFERENTIAL RESPONSE TO CONVENTIONAL THERAPY
    BONE, RC
    MAUNDER, R
    SLOTMAN, G
    SILVERMAN, H
    HYERS, TM
    KERSTEIN, MD
    URSPRUNG, JJ
    [J]. CHEST, 1989, 96 (04) : 849 - 851
  • [4] CHRONIC BILIARY OBSTRUCTION INDUCES PULMONARY INTRAVASCULAR PHAGOCYTOSIS AND ENDOTOXIN SENSITIVITY IN RATS
    CHANG, SW
    OHARA, N
    [J]. JOURNAL OF CLINICAL INVESTIGATION, 1994, 94 (05) : 2009 - 2019
  • [5] ACUTE RESPIRATORY-FAILURE - MORTALITY ASSOCIATED WITH UNDERLYING DISEASE
    COX, SC
    NORWOOD, SH
    DUNCAN, CA
    [J]. CRITICAL CARE MEDICINE, 1985, 13 (12) : 1005 - 1008
  • [6] IDENTIFICATION OF PATIENTS WITH ACUTE LUNG INJURY - PREDICTORS OF MORTALITY
    DOYLE, RL
    SZAFLARSKI, N
    MODIN, GW
    WIENERKRONISH, JP
    MATTHAY, MA
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1995, 152 (06) : 1818 - 1824
  • [7] Nosocomial pneumonia and mortality among patients in intensive care units
    Fagon, JY
    Chastre, J
    Vuagnat, A
    Trouillet, JL
    Novara, A
    Gibert, C
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (11): : 866 - 869
  • [8] High-frequency oscillatory ventilation for adult respiratory distress syndrome - A pilot study
    Fort, P
    Farmer, C
    Westerman, J
    Johannigman, J
    Beninati, W
    Dolan, S
    Derdak, S
    [J]. CRITICAL CARE MEDICINE, 1997, 25 (06) : 937 - 947
  • [9] THE FETAL HEART-RATE TRACE IS NORMAL, ISNT IT - OBSERVER AGREEMENT OF CATEGORICAL ASSESSMENTS
    GRANT, JM
    [J]. LANCET, 1991, 337 (8735) : 215 - 218
  • [10] THE MEANING AND USE OF THE AREA UNDER A RECEIVER OPERATING CHARACTERISTIC (ROC) CURVE
    HANLEY, JA
    MCNEIL, BJ
    [J]. RADIOLOGY, 1982, 143 (01) : 29 - 36