Multicenter Study

. 2017 Mar;43(3):399-407.

doi: 10.1007/s00134-016-4638-3. Epub 2016 Dec 28.

Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

Ruyang Zhang^{1

2

3}, Zhaoxi Wang¹, Paula Tejera¹, Angela J Frank⁴, Yongyue Wei^{2

3}, Li Su¹, Zhaozhong Zhu¹, Yichen Guo¹, Feng Chen^{2

3}, Ednan K Bajwa⁴, B Taylor Thompson⁴, David C Christiani^{5

6

7}

Affiliations

¹ Department of Environmental Health, Harvard School of Public Health, Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 665 Hunting Avenue, Building I Room 1401, Boston, MA, 02115, USA.
² Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China.
³ Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China.
⁴ Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Department of Environmental Health, Harvard School of Public Health, Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 665 Hunting Avenue, Building I Room 1401, Boston, MA, 02115, USA. dchris@hsph.harvard.edu.
⁶ Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China. dchris@hsph.harvard.edu.
⁷ Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. dchris@hsph.harvard.edu.

PMID: 28032130
PMCID: PMC5554539
DOI: 10.1007/s00134-016-4638-3

Multicenter Study

Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

Ruyang Zhang et al. Intensive Care Med. 2017 Mar.

. 2017 Mar;43(3):399-407.

doi: 10.1007/s00134-016-4638-3. Epub 2016 Dec 28.

Authors

Affiliations

¹ Department of Environmental Health, Harvard School of Public Health, Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 665 Hunting Avenue, Building I Room 1401, Boston, MA, 02115, USA.
² Department of Biostatistics, Ministry of Education Key Laboratory for Modern Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China.
³ Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China.
⁴ Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁵ Department of Environmental Health, Harvard School of Public Health, Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 665 Hunting Avenue, Building I Room 1401, Boston, MA, 02115, USA. dchris@hsph.harvard.edu.
⁶ Joint Laboratory of Health and Environmental Risk Assessment (HERA), Nanjing Medical University School of Public Health/Harvard School of Public Health, Nanjing, China. dchris@hsph.harvard.edu.
⁷ Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. dchris@hsph.harvard.edu.

PMID: 28032130
PMCID: PMC5554539
DOI: 10.1007/s00134-016-4638-3

Abstract

Purpose: To evaluate the association between acute respiratory distress syndrome (ARDS) onset time and prognosis.

Methods: Patients with moderate to severe ARDS (N = 876) were randomly assigned into derivation (N = 520) and validation (N = 356) datasets. Both 28-day and 60-day survival times after ARDS onset were analyzed. A data-driven cutoff point between early- and late-onset ARDS was determined on the basis of mortality risk effects of onset times. We estimated the hazard ratio (HR) and odds ratio (OR) of late-onset ARDS using a multivariate Cox proportional hazards model of survival time and a multivariate logistic regression model of mortality rate, respectively.

Results: Late-onset ARDS, defined as onset over 48 h after intensive care unit (ICU) admission (N = 273, 31%), was associated with shorter 28-day survival time: HR = 2.24, 95% CI 1.48-3.39, P = 1.24 × 10^-4 (derivation); HR = 2.16, 95% CI 1.33-3.51, P = 1.95 × 10^-3 (validation); and HR = 2.00, 95% CI 1.47-2.72, P = 1.10 × 10^-5 (combined dataset). Late-onset ARDS was also associated with shorter 60-day survival time: HR = 1.70, 95% CI 1.16-2.48, P = 6.62 × 10^-3 (derivation); HR = 1.78, 95% CI 1.15-2.75, P = 9.80 × 10^-3 (validation); and HR = 1.59, 95% CI 1.20-2.10, P = 1.22 × 10^-3 (combined dataset). Meanwhile, late-onset ARDS was associated with higher 28-day mortality rate (OR = 1.46, 95% CI 1.04-2.06, P = 0.0305) and 60-day mortality rate (OR = 1.44, 95% CI 1.03-2.02, P = 0.0313).

Conclusions: Late-onset moderate to severe ARDS patients had both shorter survival time and higher mortality rate in 28-day and 60-day observations.

Keywords: ARDS; Cox proportional hazards model; Early and late onset; Logistic regression model; Mortality rate; Overall survival time.

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Conflict of interest statement

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Diagram of ARDS patient enrollment and statistical analyses

**Fig. 2**
Kaplan–Meier curves of survival time after ARDS onset for early- and late-onset ARDS patients. ARDS onset within 48 h after admission was defined as early-onset, and otherwise as late-onset stage. HR and P value were derived from multivariate Cox proportional hazards model

See this image and copyright information in PMC

Comment in

ARDS onset time and prognosis: is it a turtle and rabbit race?
Chiumello D, Marino A. Chiumello D, et al. J Thorac Dis. 2017 Apr;9(4):973-975. doi: 10.21037/jtd.2017.03.147. J Thorac Dis. 2017. PMID: 28523151 Free PMC article. No abstract available.

References

1. Gotts JE, Matthay MA. Treating ARDS: new hope for a tough problem. Lancet Respir Med. 2014;2:84–85. - PubMed
1. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353:1685–1693. - PubMed
1. Spragg RG, Lewis JF, Walmrath HD, Johannigman J, Bellingan G, Laterre PF, Witte MC, Richards GA, Rippin G, Rathgeb F, Hafner D, Taut FJ, Seeger W. Effect of recombinant surfactant protein C-based surfactant on the acute respiratory distress syndrome. N Engl J Med. 2004;351:884–892. - PubMed
1. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354:1671–1684. - PubMed
1. Papazian L, Forel J-M, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal J-M, Perez D, Seghboyan J-M, Constantin J-M, Courant P, Lefrant J-Y, Guérin C, Prat G, Morange S, Roch A. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–1116. - PubMed

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Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

Affiliations

Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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