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Clinical Trial
. 2019 Nov;16(11):1399-1404.
doi: 10.1513/AnnalsATS.201902-116OC.

The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial

Aluko A Hope  1 , Jen-Ting Chen  1 , David A Kaufman  2 , Daniel S Talmor  3 , Daryl J Kor  4 , Ognjen Gajic  5 , Michelle N Gong  1
Affiliations
Clinical Trial

The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial

Aluko A Hope et al. Ann Am Thorac Soc. 2019 Nov.

Abstract

Rationale: No previous studies have examined the role of prehospital vulnerability in acute respiratory distress syndrome (ARDS) development and mortality in an acutely ill adult population.Objectives: To describe the association between prehospital vulnerability and 1) the development of ARDS, 2) 28-day mortality, and 3) 1-year mortality.Methods: This was a longitudinal prospective cohort study nested within the multicenter LIPS-A (Lung Injury Prevention Study-Aspirin) trial. We analyzed 301 participants who completed Vulnerable Elders Survey (VES) at baseline. Multivariable logistic regression and Cox regression analyses were used to describe the association between vulnerability and short-term outcomes (ARDS and 28-day mortality) and long-term outcomes (1-year mortality), respectively.Results: The VES score ranged from 0 to 10 (median [interquartile range], 2.0 [0-6]); 143 (47.5%) fit criteria for prehospital vulnerability (VES ≥ 3). Vulnerability was not significantly associated with ARDS development (10 [7.0%] vulnerable patients developed ARDS as per LIPS-A study criteria vs. 20 [12.7%] without vulnerability; P = 0.10; adjusted odds ratio [95% confidence interval (CI)], 0.54 [0.24-1.24]; P = 0.15). Nor was vulnerability associated with 28-day mortality (15 [10.5%] vulnerable patients were dead by Day 28 vs. 11 [7.0%] nonvulnerable patients; P = 0.28; adjusted odds ratio [95% CI], 0.95 [0.39-2.26]; P = 0.90). Vulnerability was significantly associated with 1-year mortality in hospital survivors (35 [26.9%] vs. 13 [9.3%]; adjusted hazard ratio [95% CI], 2.20 [1.10-4.37]; P = 0.02).Conclusions: In a population of adults recruited for their high risk of ARDS, prehospital vulnerability, measured by VES, was highly prevalent and strongly associated with 1-year mortality.

Keywords: acute respiratory distress syndrome; frailty; outcomes; survivors.

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Figures

Figure 1.
Figure 1.
Flow diagram of the selection of study participants and follow-up of the study sample. VES = Vulnerable Elders Survey.
Figure 2.
Figure 2.
Kaplan-Meier survival curves by prehospital vulnerability.
See this image and copyright information in PMC

References

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