Dataset Information

Predictive Role of Lung Injury Prediction Score in the Development of Acute Respiratory Distress Syndrome in Korea.

ABSTRACT:

Purpose

Early recognition and therapeutic intervention are important in patients at high risk of acute respiratory distress syndrome (ARDS). The lung injury prediction score (LIPS) has been used to predict ARDS development; however, it was developed based on the previous definition of ARDS. We investigated the predictive role of LIPS in ARDS development according to its Berlin definition in the Korean population.

Materials and methods

This was a retrospective study that enrolled adult patients admitted to the intensive care unit (ICU) at a single university-affiliated hospital in Korea from September 1, 2018, to August 31, 2019. LIPS at the time of ICU admission and the development of ARDS were evaluated.

Results

Of the 548 enrolled patients, 33 (6.0%) fulfilled the Berlin ARDS definition. The LIPS for non-ARDS and ARDS groups were 4.96±3.05 and 8.53±2.45, respectively (p<0.001); it was significantly associated with ARDS development (odds ratio 1.48, 95% confidence interval, 1.29-1.69; p<0.001). LIPS >6 predicted the development of ARDS with a sensitivity of 84.8% and a specificity of 67.2% [area under the curve (AUC)=0.82]. A modified LIPS model adjusted for age and severity at ICU admission predicted ICU mortality in patients with ARDS (AUC=0.80), but not in those without ARDS (AUC=0.54).

Conclusion

LIPS predicted the development of ARDS as diagnosed by the Berlin definition in the Korean population. LIPS provides useful information for managing patients with ARDS.

SUBMITTER: Kim BK

PROVIDER: S-EPMC8084702 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveThe Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact.DesignRetrospective study.SettingFive academic medical centers.PatientsNine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact.InterventionsNone.Measurements and main resultsLung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2-3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21-1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18-1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26-7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68-3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05-6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value.ConclusionsIn a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.

Project description:BackgroundEarly recognition of the risks of acute respiratory distress syndrome (ARDS) and prevention of the development of ARDS may be more effective in improving patient outcomes. We performed the present study to determine the ARDS risk factors in a Chinese population and validate a score to predict the development of ARDS.MethodsThis was an observational multicenter cohort study performed in 13 tertiary hospitals in China. Patients admitted into participating intensive care units (ICUs) from January 1 to January 31, 2012, and from January 1 to January 10, 2013, were enrolled in a retrospective derivation cohort and a prospective validation cohort, respectively. In the derivation cohort, the potential risk factors of ARDS were collected. The confirmed risk factors were determined with univariate and multivariate logistic regression analyses, and then the modified ARDS prediction score (MAPS) was established. We prospectively enrolled patients to verify the accuracy of MAPS.ResultsA total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 [95% confidence interval (CI), 0.758-0.859, P<0.001]. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717-0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728-0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046).ConclusionsThe MAPS based on risk factors could help the clinician to predict patients who will develop ARDS.Trial registrationClinicalTrials.gov NCT01666834.