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Observational Study
. 2019 Feb 11;19(1):37.
doi: 10.1186/s12890-019-0803-0.

Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients

Tetsuro Kamo  1 , Sadatomo Tasaka  2   3 , Takeshi Suzuki  4 , Takanori Asakura  1 , Shoji Suzuki  1 , Kazuma Yagi  1 , Ho Namkoong  1 , Makoto Ishii  1 , Hiroshi Morisaki  4 , Tomoko Betsuyaku  1
Affiliations
Observational Study

Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients

Tetsuro Kamo et al. BMC Pulm Med. .

Abstract

Background: In the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients.

Methods: In this study, we examined the associations between the Berlin definition criteria and prognosis and clinical parameters, including high-resolution computed tomography (HRCT) scores of fibroproliferative changes of the lungs. One hundred fifty-three patients (45 females; mean age, 67 y/o), who met the Berlin definition and received treatment in our intensive care unit between January 2012 and December 2015, were enrolled.

Results: The severity of ARDS was mild in 42 patients, moderate in 71, and severe in 40. The underlying diseases included pneumonia in 56 patients and aspiration in 43. Forty-two (27.5%) patients were deceased within 30 days, and the 30-day mortality was 10% in mild ARDS, 23% in moderate, and 55% in severe, which were significantly different (P < 0.05). In the non-survivors, APACHE II, SOFA, and SAPS II scores were higher than in the survivors (P < 0.001). Multivariate analyses revealed that elevated blood lactate level (≥ 2.0 mmol/L) and increased HRCT scores were significantly associated with weaning failure and 30-day mortality of the patients with ARDS.

Conclusions: These results suggested that the severity criteria in the Berlin definition might be associated with the prognosis of the patients. Blood lactate levels and HRCT score might be predictive of the outcome of patients with ARDS.

Keywords: ARDS; Berlin definition; High-resolution computed tomography; Lactate; Mortality.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the ethics committee of Keio University School of Medicine (approval number: 20160010), and written informed consent was waived because of the retrospective design.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for the patient survival
Fig. 2
Fig. 2
Correlation between the HRCT score and PaO2/FIO2 ratio. The HRTCT score was inversely correlated with PaO2/FIO2 ratio (ρ = − 0.258, P = 0.002)
See this image and copyright information in PMC

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