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Multicenter Study
. 2016 Dec;44(12):2182-2191.
doi: 10.1097/CCM.0000000000002001.

Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

Graciela J Soto  1 , Daryl J Kor, Pauline K Park, Peter C Hou, David A Kaufman, Mimi Kim, Hemang Yadav, Nicholas Teman, Michael C Hsu, Tatyana Shvilkina, Yekaterina Grewal, Manuel De Aguirre, Sampath Gunda, Ognjen Gajic, Michelle Ng Gong
Affiliations
Multicenter Study

Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

Graciela J Soto et al. Crit Care Med. 2016 Dec.

Abstract

Objective: The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact.

Design: Retrospective study.

Setting: Five academic medical centers.

Patients: Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact.

Interventions: None.

Measurements and main results: Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2-3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21-1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18-1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26-7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68-3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05-6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value.

Conclusions: In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.

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Figures

Figure 1
Figure 1. Outline of Screening Protocol and Data Collection
aExclusion criteria are not mutually exclusive; therefore, patients with more than 1 exclusion may be counted more than once ABG, arterial blood gas ARDS, acute respiratory distress syndrome DNR/DNI, do-not-resuscitate/do-not-intubate ED, emergency department ICU, intensive care unit LIPS, lung injury prediction score
Figure 2
Figure 2. Timing of ARDS development by Study Day
ARDS, acute respiratory distress syndrome
Figure 3
Figure 3. Rate of ARDS development and Composite Outcome by LIPS
a p value is for the association between the rate of ARDS development or Composite Outcome by increasing LIPS points ARDS, acute respiratory distress syndrome LIPS, lung injury prediction score Composite Outcome, onset of ARDS or death during the hospitalization
See this image and copyright information in PMC

Comment in

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