4.6 Article

Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

期刊

CRITICAL CARE MEDICINE
卷 44, 期 12, 页码 2182-2191

出版社

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000002001

关键词

acute respiratory distress syndrome; acute respiratory failure; mortality; prediction model; prevention

资金

  1. NCATS [UL1 TR001073]
  2. NHLBI [3HL112855, R01 HL121232, U01 HL108712-01, HL125119, HL122998]
  3. Brigham and Women's Hospital Biomedical Research Institute Microgrant
  4. National Institutes of Health (NIH)
  5. Critical Care Roundtable
  6. NIH-National Heart, Lung, and Blood Institute (NHLBI)
  7. Lupus foundation
  8. Center for Medicare and Medicaid Services

向作者/读者索取更多资源

Objective: The 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. Design: Retrospective study. Setting: Five academic medical centers. Patients: Nine hundred consecutive patients 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact. Interventions: None. Measurements and Main Results: Lung 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. Conclusions: In 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.

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