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. 2021 May 26;10(11):2323.
doi: 10.3390/jcm10112323.

Prognostic Factors to Predict ICU Mortality in Patients with Severe ARDS Who Received Early and Prolonged Prone Positioning Therapy

Po-Hsin Lee  1 , Chen-Tsung Kuo  2 , Chiann-Yi Hsu  3 , Shih-Pin Lin  4 , Pin-Kuei Fu  4   5   6   7
Affiliations

Prognostic Factors to Predict ICU Mortality in Patients with Severe ARDS Who Received Early and Prolonged Prone Positioning Therapy

Po-Hsin Lee et al. J Clin Med. .

Abstract

Early and prolonged prone positioning (PP) therapy improve survival in advanced ARDS; however, the predictors of mortality remain unclear. The study aims to identify predictive factors correlated with mortality and build-up the prognostic score in patients with severe ARDS who received early and prolonged PP therapy. A total of 116 patients were enrolled in this retrospective cohort study. Univariate and multivariate regression models were used to estimate the odds ratio (OR) of mortality. Factors associated with mortality were assessed by Cox regression analysis and presented as the hazard ratio (HR) and 95% CI. In the multivariate regression model, renal replacement therapy (RRT; OR: 4.05, 1.54-10.67), malignant comorbidity (OR: 8.86, 2.22-35.41), and non-influenza-related ARDS (OR: 5.17, 1.16-23.16) were significantly associated with ICU mortality. Age, RRT, non-influenza-related ARDS, malignant comorbidity, and APACHE II score were included in a composite prone score, which demonstrated an area under the curve of 0.816 for predicting mortality risk. In multivariable Cox proportional hazard model, prone score more than 3 points was significantly associated with ICU mortality (HR: 2.13, 1.12-4.07, p = 0.021). We suggest prone score ≥3 points could be a good predictor for mortality in severe ARDS received PP therapy.

Keywords: ICU mortality; acute respiratory distress syndrome; prognostic factors; prone positioning.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Enrollment and follow-up of the study participants. ARDS, acute respiratory distress syndrome; FiO2, fraction concentration of inspired oxygen; ECMO, extracorporeal membrane oxygenation; ICU: intensive care unit.
Figure 2
Figure 2
Receiver operating curves analysis of age, APACHE II score, and prone score for predicting ICU mortality in patients with acute respiratory distress syndrome receiving early and prolonged prone positioning.
Figure 3
Figure 3
Prone score ≥ 3 was significantly associated with higher mortality in patients with severe ARDS received prone positioning therapy. p < 0.001.
See this image and copyright information in PMC

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