Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients
Introduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU)...
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/4/1252 |
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| author | Daan F. L. Filippini Laura A. Hagens Nanon F. L. Heijnen Claudio Zimatore Leila N. Atmowihardjo Ronny M. Schnabel Marcus J. Schultz Dennis C. J. J. Bergmans Lieuwe D. J. Bos Marry R. Smit |
| author_facet | Daan F. L. Filippini Laura A. Hagens Nanon F. L. Heijnen Claudio Zimatore Leila N. Atmowihardjo Ronny M. Schnabel Marcus J. Schultz Dennis C. J. J. Bergmans Lieuwe D. J. Bos Marry R. Smit |
| author_sort | Daan F. L. Filippini |
| collection | DOAJ |
| description | Introduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU) with respiratory failure not due to ARDS, a variable degree of lung edema is observed as well. We aimed to evaluate the prognostic value of RALE in mechanically ventilated ICU patients. Methods: Secondary analysis of patients enrolled in the ‘Diagnosis of Acute Respiratory Distress Syndrome’ (DARTS) project with an available chest X-ray (CXR) at baseline. Where present, additional CXRs at day 1 were analysed. The primary endpoint was 30-day mortality. Outcomes were also stratified for ARDS subgroups (no ARDS, non-COVID-ARDS and COVID-ARDS). Results: 422 patients were included, of which 84 had an additional CXR the following day. Baseline RALE scores were not associated with 30-day mortality in the entire cohort (OR: 1.01, 95% CI: 0.98–1.03, <i>p</i> = 0.66), nor in subgroups of ARDS patients. Early changes in RALE score (baseline to day 1) were only associated with mortality in a subgroup of ARDS patients (OR: 1.21, 95% CI: 1.02–1.51, <i>p</i> = 0.04), after correcting for other known prognostic factors. Conclusions: The prognostic value of the RALE score cannot be extended to mechanically ventilated ICU patients in general. Only in ARDS patients, early changes in RALE score were associated with mortality. |
| first_indexed | 2024-03-11T08:39:12Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T08:39:12Z |
| publishDate | 2023-02-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ebe3f605c4b2422baa446b88124e659c2023-11-16T21:17:01ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01124125210.3390/jcm12041252Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU PatientsDaan F. L. Filippini0Laura A. Hagens1Nanon F. L. Heijnen2Claudio Zimatore3Leila N. Atmowihardjo4Ronny M. Schnabel5Marcus J. Schultz6Dennis C. J. J. Bergmans7Lieuwe D. J. Bos8Marry R. Smit9Department of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Maastricht UMC+, Maastricht University, 6229 HX Maastricht, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Maastricht UMC+, Maastricht University, 6229 HX Maastricht, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Maastricht UMC+, Maastricht University, 6229 HX Maastricht, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsDepartment of Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The NetherlandsIntroduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU) with respiratory failure not due to ARDS, a variable degree of lung edema is observed as well. We aimed to evaluate the prognostic value of RALE in mechanically ventilated ICU patients. Methods: Secondary analysis of patients enrolled in the ‘Diagnosis of Acute Respiratory Distress Syndrome’ (DARTS) project with an available chest X-ray (CXR) at baseline. Where present, additional CXRs at day 1 were analysed. The primary endpoint was 30-day mortality. Outcomes were also stratified for ARDS subgroups (no ARDS, non-COVID-ARDS and COVID-ARDS). Results: 422 patients were included, of which 84 had an additional CXR the following day. Baseline RALE scores were not associated with 30-day mortality in the entire cohort (OR: 1.01, 95% CI: 0.98–1.03, <i>p</i> = 0.66), nor in subgroups of ARDS patients. Early changes in RALE score (baseline to day 1) were only associated with mortality in a subgroup of ARDS patients (OR: 1.21, 95% CI: 1.02–1.51, <i>p</i> = 0.04), after correcting for other known prognostic factors. Conclusions: The prognostic value of the RALE score cannot be extended to mechanically ventilated ICU patients in general. Only in ARDS patients, early changes in RALE score were associated with mortality.https://www.mdpi.com/2077-0383/12/4/1252intensive carecritical caremechanical ventilationARDSprognosticationmortality |
| spellingShingle | Daan F. L. Filippini Laura A. Hagens Nanon F. L. Heijnen Claudio Zimatore Leila N. Atmowihardjo Ronny M. Schnabel Marcus J. Schultz Dennis C. J. J. Bergmans Lieuwe D. J. Bos Marry R. Smit Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients Journal of Clinical Medicine intensive care critical care mechanical ventilation ARDS prognostication mortality |
| title | Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients |
| title_full | Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients |
| title_fullStr | Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients |
| title_full_unstemmed | Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients |
| title_short | Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients |
| title_sort | prognostic value of the radiographic assessment of lung edema score in mechanically ventilated icu patients |
| topic | intensive care critical care mechanical ventilation ARDS prognostication mortality |
| url | https://www.mdpi.com/2077-0383/12/4/1252 |
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