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. 2017 Jul 5;12(7):e0180018.
doi: 10.1371/journal.pone.0180018. eCollection 2017.

Survival predictor in patients with acute respiratory distress syndrome and diffuse alveolar damage undergoing open lung biopsy

Kuo-Chin Kao  1   2 , Chih-Hao Chang  1 , Chen-Yiu Hung  1 , Li-Chung Chiu  1 , Chung-Chi Huang  1   2 , Han-Chung Hu  1   2
Affiliations

Survival predictor in patients with acute respiratory distress syndrome and diffuse alveolar damage undergoing open lung biopsy

Kuo-Chin Kao et al. PLoS One. .

Abstract

Background: Diffuse alveolar damage (DAD) is a typical pathological finding of open lung biopsies in patients with acute respiratory distress syndrome (ARDS). Patients with ARDS and DAD have been reported to have a poorer prognosis than those without DAD. The aim of this study was to investigate the survival predictors in patients with ARDS and DAD.

Methods: We retrospectively reviewed all ARDS patients who underwent an open lung biopsy which showed evidence of DAD from January 2006 to June 2015 at Chang Gung Memorial Hospital. Clinical data including baseline characteristics, medication, and survival outcomes were analyzed.

Results: A total of 64 ARDS patients with DAD were eligible for analysis and divided into known etiology (n = 17, 26.6%) and unknown etiology groups (n = 47, 73.4%). There was no significant difference in hospital mortality rate between the two groups (71.9% vs. 70.6%, p = 0.890). Univariate logistic regression analysis revealed that sequential organ failure assessment (SOFA) score at the time of a diagnosis of ARDS, and SOFA score, PaO2/FiO2 ratio, and positive end expiratory pressure level when the biopsy was performed were associated with hospital mortality. Multivariate analysis showed that the SOFA score on the day of the biopsy was an independent predictor of hospital mortality (odds ratio 1.413, 95% confidence interval 1.127-1.772; p = 0.03). There were no significant differences in the use, dose, duration and timing from ARDS to glucocorticoid therapy between the survivors and nonsurvivors.

Conclusion: For selected ARDS patients who underwent an open lung biopsy with pathological DAD, SOFA score was an independent predictor of hospital mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart for patients’ enrollment in this study.
ARDS, acute respiratory distress syndrome, DAD diffuse alveolar damage.
See this image and copyright information in PMC

References

    1. Katzenstein AL, Bloor CM, Leibow AA. (1976) Diffuse alveolar damage—the role of oxygen, shock, and related factors: a review. Am J Pathol 85: 209–228. - PMC - PubMed
    1. Tomashefski JF Jr. (2000) Pulmonary pathology of acute respiratory distress syndrome: Clin Chest Med 21: 435–466. - PubMed
    1. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. (2012) The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 38: 1573–1582. doi: 10.1007/s00134-012-2682-1 - DOI - PubMed
    1. Guerin C, Bayle F, Leray V, Debord S, Stoian A, Yonis H, et al. (2015) Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management. Intensive Care Med 41: 222–230. doi: 10.1007/s00134-014-3583-2 - DOI - PubMed
    1. Kao KC, Hu HC, Chang CH, Hung CY, Chiu LC, Li SH, et al. (2015) Diffuse alveolar damage associated mortality in selected acute respiratory distress syndrome patients with open lung biopsy. Crit Care 19: 228 doi: 10.1186/s13054-015-0949-y - DOI - PMC - PubMed

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