Early Identification of Patients at Risk of Acute Lung Injury Evaluation of Lung Injury Prediction Score in a Multicenter Cohort Study

被引：453

作者：

Gajic, Ognien ^{[1
]}

Dabbagh, Ousama ^{[2
]}

Park, Pauline K. ^{[3
]}

Adesanya, Adebola ^{[4
]}

Chang, Steven Y. ^{[5
]}

Hou, Peter ^{[6
]}

Anderson, Harry, III ^{[7
,8
]}

Hoth, J. Jason ^{[9
]}

Mikkelsen, Mark E. ^{[10
]}

Gentile, Nina T. ^{[11
]}

Gong, Michelle N. ^{[12
]}

Talmor, Daniel ^{[13
]}

Bajwa, Ednan ^{[14
]}

Watkins, Timothy R. ^{[15
]}

Festic, Emir ^{[16
]}

Yilmaz, Murat ^{[17
]}

Iscimen, Remzi ^{[18
]}

Kaufman, David A. ^{[19
]}

Esper, Annette M. ^{[20
]}

Sadikot, Ruxana ^{[21
]}

Douglas, Ivor ^{[22
]}

Sevransky, Jonathan ^{[23
]}

Malinchoc, Michael ^{[1
]}

机构：

[1] Mayo Clin, Rochester, MN 55905 USA

[2] Univ Missouri, Columbia, MO USA

[3] Univ Michigan, Ann Arbor, MI 48109 USA

[4] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

[5] Univ Med & Dent New Jersey, Newark, NJ 07103 USA

[6] Brigham & Womens Hosp, Boston, MA 02115 USA

[7] Wright State Univ, Boonshoft Sch Med, Dayton, OH 45435 USA

[8] Miami Valley Hosp, Dayton, OH USA

[9] Wake Forest Univ Hlth Sci, Winston Salem, NC USA

[10] Univ Penn, Philadelphia, PA 19104 USA

[11] Temple Univ, Sch Med, Philadelphia, PA 19122 USA

[12] Mt Sinai Sch Med, New York, NY USA

[13] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[14] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Boston, MA USA

[15] Univ Washington, Harborview, WA USA

[16] Mayo Clin, Jacksonville, FL 32224 USA

[17] Akdeniz Univ, Antalyia, Turkey

[18] Uludag Univ, Bursa, Turkey

[19] Bridgeport Hosp, New Haven, CT USA

[20] Emory Univ, Atlanta, GA 30322 USA

[21] Univ Illinois, Chicago, IL USA

[22] Univ Colorado, Denver, CO 80202 USA

[23] Johns Hopkins Univ, Baltimore, MD USA

来源：

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE | 2011年 / 183卷 / 04期

关键词：

respiratory distress syndrome; adult; prevention; prediction model; acute respiratory failure; RESPIRATORY-DISTRESS-SYNDROME; COMMUNITY-ACQUIRED PNEUMONIA; INTENSIVE-CARE-UNIT; CONSENSUS CONFERENCE; CLINICAL PREDICTORS; VENTILATOR SETTINGS; ACUTE-PANCREATITIS; RELEVANT OUTCOMES; SEVERITY SCORES; VALIDATION;

D O I：

10.1164/rccm.201004-0549OC

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies. Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS). Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions. Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk All developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80(95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7). Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772).

引用

页码：462 / 470

页数：9

共 53 条

[11] Prospective Comparison of Severity Scores for Predicting Clinically Relevant Outcomes for Patients Hospitalized With Community-Acquired Pneumonia [J].