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Observational Study
. 2016 Nov 8;16(1):108.
doi: 10.1186/s12871-016-0272-4.

Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study

Felix Balzer  1 , Mario Menk  1 , Jannis Ziegler  2 , Christian Pille  1 , Klaus-Dieter Wernecke  3 , Claudia Spies  1 , Maren Schmidt  4 , Steffen Weber-Carstens  5 , Maria Deja  6   7
Affiliations
Observational Study

Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study

Felix Balzer et al. BMC Anesthesiol. .

Abstract

Background: Currently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. This study aimed to examine the predictive values of the AECC and Berlin definitions, as well as clinical and respiratory parameters obtained at onset of ARDS and in the course of the first seven consecutive days.

Methods: The observational study was conducted at a 14-bed intensive care unit specialized on treatment of ARDS. Predictive validity of the AECC and Berlin definitions as well as PaO2/FiO2 and FiO2/PaO2*Pmean (oxygenation index) on mortality of ARDS patients was assessed and statistically compared.

Results: Four hundred forty two critically-ill patients admitted for ARDS were analysed. Multivariate Cox regression indicated that the oxygenation index was the most accurate parameter for mortality prediction. The third day after ARDS criteria were met at our hospital was found to represent the best compromise between earliness and accuracy of prognosis of mortality regarding the time of assessment. An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. In addition, non-survivors had a significantly longer length of stay and duration of mechanical ventilation in referring hospitals before admitted to the national reference centre than survivors.

Conclusions: The oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. Patients might benefit when transferred to specialized ICU centres as soon as possible for further treatment.

Keywords: Acute respiratory distress syndrome; Classification; Outcome; Oxygenation index; Pao2/FIO2 ratio; Risk stratification.

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Figures

Fig. 1
Fig. 1
Predicitive validity for in-hospital mortality for the first seven days of ARDS after its diagnosis for AECC and Berlin Definition of ARDS, paO2/FiO2, and oxygenation index. Area under ROC curve shown for the first seven days of ARDS by 4 categorizing options of severity of lung failure: AECC and Berlin Definition of ARDS, paO2/FiO2 and OI
Fig. 2
Fig. 2
Survival curves for AECC and Berlin definition of acute respiratory distress syndrome, PaO2/FiO2 ratio and OI on day 3. Three hundred seventy nine patients had a PaO2/FiO2 ratio ≤ 300 mmHg on day 3 and have been grouped in the corresponding stages of the AECC (a) and Berlin definition (b). In total, PaO2/FiO2 was available for all 411 patients alive on day 3 (c). Values for FiO2/PaO2*Pmean were available for 391 patients being mechanically ventilated on that day (d). AECC: American-European Consensus Conference; F i O 2 : inspiratory fraction of oxygen; F i O 2 /P a O 2 * P mean describes oxygenation index. P a O 2 : arterial partial pressure of oxygen; P mean : mean airway pressure, OI: oxygenation index
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