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Multicenter Study
. 2014 Mar;40(3):388-96.
doi: 10.1007/s00134-013-3186-3. Epub 2014 Jan 17.

One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome

Chen Yu Wang  1 , Carolyn S Calfee, Devon W Paul, David R Janz, Addison K May, Hanjing Zhuo, Gordon R Bernard, Michael A Matthay, Lorraine B Ware, Kirsten Neudoerffer Kangelaris
Affiliations
Multicenter Study

One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome

Chen Yu Wang et al. Intensive Care Med. 2014 Mar.

Abstract

Purpose: Advances in supportive care and ventilator management for acute respiratory distress syndrome (ARDS) have resulted in declines in short-term mortality, but risks of death after survival to hospital discharge have not been well described. Our objective was to quantify the difference between short-term and long-term mortality in ARDS and to identify risk factors for death and causes of death at 1 year among hospital survivors.

Methods: This multi-intensive care unit, prospective cohort included patients with ARDS enrolled between January 2006 and February 2010. We determined the clinical characteristics associated with in-hospital and 1-year mortality among hospital survivors and utilized death certificate data to identify causes of death.

Results: Of 646 patients hospitalized with ARDS, mortality at 1 year was substantially higher (41 %, 95% CI 37-45%) than in-hospital mortality (24%, 95% CI 21-27%), P < 0.0001. Among 493 patients who survived to hospital discharge, the 110 (22%) who died in the subsequent year were older (P < 0.001) and more likely to have been discharged to a nursing home, other hospital, or hospice compared to patients alive at 1 year (P < 0.001). Important predictors of death among hospital survivors were comorbidities present at the time of ARDS, and not living at home prior to admission. ARDS-related measures of severity of illness did not emerge as independent predictors of mortality in hospital survivors.

Conclusions: Despite improvements in short-term ARDS outcomes, 1-year mortality is high, mostly because of the large burden of comorbidities, which are prevalent in patients with ARDS.

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Figures

Fig. 1
Fig. 1
Probability of survival to 1 year of follow-up among hospital survivors according to discharge location. Whereas 15 % (34/230) and 13 % (15/115) of patients discharged to home or rehabilitation died in the year of follow-up, respectively, 25 % (19/76) transferred to another hospital, 38 % (19/50) discharged to a nursing home, and 96 % (22/23) discharged to hospice care died. The differences in survival across groups are statistically significant (P < 0.001) driven by significantly increased 1-year mortality among patients discharged to hospice (P < 0.001), nursing home (P < 0.001), and other hospital (P = 0.03) compared to discharge to home
Fig. 2
Fig. 2
Underlying causes of death in patients with ALI/ARDS who died during the hospital stay (gray bars) and those who survived hospitalization but died during the year following enrollment (black bars). In both groups, the most common cause of death was underlying malignancy. No difference is statistically significant
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