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Abstract

Introduction: Lung injury prediction score has been shown to be a valuable tool for early recognition of those ventilated patients at high risk of developing acute respiratory distress syndrome (ARDS). This study analyzes the value of the LIPS in predicting ARDS and mortality among surgically ventilated patients. Methods: IRB approved, prospective observational cohort study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary, academic center over a 6-month period. ARDS was defined using the Berlin criteria. Lung injury prediction scores (LIPS) were calculated for all enrolled patients. LIPS were subdivided into 0-3.5, 4-5.5, 6-7.5, 8-9.5 and > 10. Univariate and multivariate logistic regression models were performed using SAS 9.2 to evaluate the ability of each LIPS subdivision to predict the development of ARDS as well as overall mortality. Statistical significance was set at p<0.05. Results: 268 total patients enrolled, 141 (52.6%) who developed ARDS and 127 (47.4%) who did not develop ARDS. LIPS subdivisions were analyzed; 0-3.5 subdivision had 35 (27.6%) patients without ARDS and 4 (2.8%) patients with ARDS, 4-5.5 subdivision had 41 (32.3%) patients without ARDS and 19 (13.5%) patients with ARDS, 6-7.5 subdivision had 20 (15.8%) patients without ARDS and 34 (24.1%) patients with ARDS, subdivision 8-9.5 had 21 (16.5%) patients without ARDS and 32 (22.7%) patients with ARDS, and subdivision > 10 had 10 (7.9%) patients without ARDS and 52 (36.9%) patients with ARDS (p<0.001). When compared to a LIPS of <3.5, LIPS of 6-7.5 had an OR of 14.88 for developing ARDS, 8-9.5 had an OR of 13.33, and > 10 had an OR of 45.50 (p<0.001). For every 1-unit increase in LIPS, the odds of developing ARDS increases by 1.50 (p<0.001) and the odds of mortality increases by 1.22 (p<0.001). Compared to a LIPS of <3.5, LIPS of > 10 has a 15.53 OR of death (p=0.009). Conclusions: LIPS is a reliable method for predicting the development of ARDS as well as mortality in surgical critical care patients. Our study suggests a LIPS of 6 as the transition point for considering a patient high risk for developing ARDS. This tool should be utilized in ventilated patients to guide early intervention to prevent the development of ARDS.