Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
Abstract Background Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients wit...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2017-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-017-0281-6 |
| _version_ | 1811260112681041920 |
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| author | Nicolas de Prost Tài Pham Guillaume Carteaux Armand Mekontso Dessap Christian Brun-Buisson Eddy Fan Giacomo Bellani John Laffey Alain Mercat Laurent Brochard Bernard Maître for the LUNG SAFE investigators the ESICM trials group the REVA network |
| author_facet | Nicolas de Prost Tài Pham Guillaume Carteaux Armand Mekontso Dessap Christian Brun-Buisson Eddy Fan Giacomo Bellani John Laffey Alain Mercat Laurent Brochard Bernard Maître for the LUNG SAFE investigators the ESICM trials group the REVA network |
| author_sort | Nicolas de Prost |
| collection | DOAJ |
| description | Abstract Background Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or without risk factors, the impact on hospital mortality, and to assess the diagnostic work-up performed. The current study is an ancillary analysis of an international, multicenter, prospective cohort study (the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure, LUNG SAFE). Patients meeting ARDS criteria within 2 days of acute hypoxemic respiratory failure onset were included in the study and categorized as having risk factors or not. Outcomes were compared using propensity score matching. Results Among 2813 patients, 234 (8.3% [7.3–9.3]) had no ARDS risk factor identified. These were older, had more frequent chronic diseases and presented with less severe SOFA and non-pulmonary SOFA scores (p < 0.001). Compared to other ARDS, CT scan (32.1 vs 23.9%, p < 0.001) and open lung biopsy (2.6 vs 0.2%, p < 0.001) were slightly more frequent but left heart filling pressures assessment was not (69.4 vs 68.4%, p > 0.99). Among ARDS with no risk factor, 45 patients (19.2%) had a specific diagnosis made. As compared to others, patients having ARDS with no risk factor had a lower ICU but not hospital mortality (34.6 vs 40.0%; p = 0.12). A matched cohort analysis confirmed the lack of significant difference in mortality. Conclusion Eight percent of ARDS patients have no identified risk factor, 80% of whom have no etiological diagnosis made. The outcome of ARDS with no risk factor was comparable to other ARDS but few had a comprehensive diagnostic work-up, potentially leading to missed curable diseases. Trial registration clinicaltrials.gov Identifier: NCT02010073 |
| first_indexed | 2024-04-12T18:41:43Z |
| format | Article |
| id | doaj.art-943c533405274ef087c06ae703c6b1c3 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-04-12T18:41:43Z |
| publishDate | 2017-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-943c533405274ef087c06ae703c6b1c32022-12-22T03:20:45ZengSpringerOpenAnnals of Intensive Care2110-58202017-06-017111210.1186/s13613-017-0281-6Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter studyNicolas de Prost0Tài Pham1Guillaume Carteaux2Armand Mekontso Dessap3Christian Brun-Buisson4Eddy Fan5Giacomo Bellani6John Laffey7Alain Mercat8Laurent Brochard9Bernard Maître10for the LUNG SAFE investigatorsthe ESICM trials groupthe REVA networkService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de ParisGroupe hospitalier des Hôpitaux Universitaires de l’Est Parisien, Pôle Thorax Voies aériennes, Unité de Réanimation médico-chirurgicale, Hôpital Tenon, AP-HPService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de ParisService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de ParisService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de ParisInterdepartmental Division of Critical Care Medicine, University of TorontoSchool of Medicine and Surgery, University of Milan-BicoccaDepartments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael’s HospitalService de Réanimation Médicale, Centre Hospitalier Universitaire d’AngersKeenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s HospitalService de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de ParisAbstract Background Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or without risk factors, the impact on hospital mortality, and to assess the diagnostic work-up performed. The current study is an ancillary analysis of an international, multicenter, prospective cohort study (the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure, LUNG SAFE). Patients meeting ARDS criteria within 2 days of acute hypoxemic respiratory failure onset were included in the study and categorized as having risk factors or not. Outcomes were compared using propensity score matching. Results Among 2813 patients, 234 (8.3% [7.3–9.3]) had no ARDS risk factor identified. These were older, had more frequent chronic diseases and presented with less severe SOFA and non-pulmonary SOFA scores (p < 0.001). Compared to other ARDS, CT scan (32.1 vs 23.9%, p < 0.001) and open lung biopsy (2.6 vs 0.2%, p < 0.001) were slightly more frequent but left heart filling pressures assessment was not (69.4 vs 68.4%, p > 0.99). Among ARDS with no risk factor, 45 patients (19.2%) had a specific diagnosis made. As compared to others, patients having ARDS with no risk factor had a lower ICU but not hospital mortality (34.6 vs 40.0%; p = 0.12). A matched cohort analysis confirmed the lack of significant difference in mortality. Conclusion Eight percent of ARDS patients have no identified risk factor, 80% of whom have no etiological diagnosis made. The outcome of ARDS with no risk factor was comparable to other ARDS but few had a comprehensive diagnostic work-up, potentially leading to missed curable diseases. Trial registration clinicaltrials.gov Identifier: NCT02010073http://link.springer.com/article/10.1186/s13613-017-0281-6Respiratory distress syndrome, adultBerlin definitionOutcomesDiagnostic techniques and procedures |
| spellingShingle | Nicolas de Prost Tài Pham Guillaume Carteaux Armand Mekontso Dessap Christian Brun-Buisson Eddy Fan Giacomo Bellani John Laffey Alain Mercat Laurent Brochard Bernard Maître for the LUNG SAFE investigators the ESICM trials group the REVA network Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study Annals of Intensive Care Respiratory distress syndrome, adult Berlin definition Outcomes Diagnostic techniques and procedures |
| title | Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study |
| title_full | Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study |
| title_fullStr | Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study |
| title_full_unstemmed | Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study |
| title_short | Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study |
| title_sort | etiologies diagnostic work up and outcomes of acute respiratory distress syndrome with no common risk factor a prospective multicenter study |
| topic | Respiratory distress syndrome, adult Berlin definition Outcomes Diagnostic techniques and procedures |
| url | http://link.springer.com/article/10.1186/s13613-017-0281-6 |
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