RT Journal Article
SR Electronic
T1 A Risk Tertiles Model for Predicting Mortality in Patients With Acute Respiratory Distress Syndrome: Age, Plateau Pressure, and P<sub>aO<sub>2</sub></sub>/F<sub>IO<sub>2</sub></sub> at ARDS Onset Can Predict Mortality
JF Respiratory Care
FD American Association for Respiratory Care
SP 420
OP 428
DO 10.4187/respcare.00811
VO 56
IS 4
A1 Jesús Villar
A1 Lina Pérez-Méndez
A1 Santiago Basaldúa
A1 Jesús Blanco
A1 Gerardo Aguilar
A1 Darío Toral
A1 Elizabeth Zavala
A1 Miguel A Romera
A1 Gumersindo González-Díaz
A1 Frutos del Nogal
A1 Antonio Santos-Bouza
A1 Luís Ramos
A1 Santiago Macías
A1 Robert M Kacmarek
A1 Hospitales Españoles Para el Estudio de la Lesión Pulmonar (HELP) Network
YR 2011
UL http://rc.rcjournal.com/content/56/4/420.abstract
AB BACKGROUND: Predicting mortality has become a necessary step for selecting patients for clinical trials and defining outcomes. We examined whether stratification by tertiles of respiratory and ventilatory variables at the onset of acute respiratory distress syndrome (ARDS) identifies patients with different risks of death in the intensive care unit. METHODS: We performed a secondary analysis of data from 220 patients included in 2 multicenter prospective independent trials of ARDS patients mechanically ventilated with a lung-protective strategy. Using demographic, pulmonary, and ventilation data collected at ARDS onset, we derived and validated a simple prediction model based on a population-based stratification of variable values into low, middle, and high tertiles. The derivation cohort included 170 patients (all from one trial) and the validation cohort included 50 patients (all from a second trial). RESULTS: Tertile distribution for age, plateau airway pressure (Pplat), and PaO2/FIO2 at ARDS onset identified subgroups with different mortalities, particularly for the highest-risk tertiles: age (&gt; 62 years), Pplat (&gt; 29 cm H2O), and PaO2/FIO2 (&lt; 112 mm Hg). Risk was defined by the number of coexisting high-risk tertiles: patients with no high-risk tertiles had a mortality of 12%, whereas patients with 3 high-risk tertiles had 90% mortality (P &lt; .001). CONCLUSIONS: A prediction model based on tertiles of patient age, Pplat, and PaO2/FIO2 at the time the patient meets ARDS criteria identifies patients with the lowest and highest risk of intensive care unit death.