A Predictive Model for Acute Respiratory Distress Syndrome Mortality Using Red Cell Distribution Width.

Ala Alkhatib,Peter Lacamera,Lori Lyn Price,Rania Esteitie

doi:10.1155/2020/3832683

Abstract

Methods This observational retrospective cohort study includes 318 ARDS patients extracted from an ICU database between the years of 2001 and 2008. Clinical factors including age, gender, comorbidity score, Sequential Organ Failure Assessment (SOFA) score, and PaO2/FiO2 ratio were chosen for the base model to predict ICU mortality. The RDW value at the time of ARDS diagnosis was added to the base model to determine if it improved its predictive ability. Results 318 subjects were included; 113 (36%) died in the ICU. AUC for the base model without RDW was 0.76, and 0.78 following the addition of RDW [p=0.048]. The NRI was 0.46 (p=0.001), indicating that, in 46% of patients, the predictive probability of the model was improved by the inclusion of RDW. Conclusions Adding RDW at time of ARDS diagnosis improved discrimination in a model using 4 clinical factors to predict ICU mortality.

Highlights

Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory response of the lung to stressful pulmonary or extrapulmonary processes [1]
Because of the known high mortality rate of ARDS, many studies have examined risk factors associated with severity and mortality. ese efforts have identified age, comorbidities, presence of multiorgan dysfunction, and lung disease severity as factors correlating with ARDS outcomes [2,3,4]
We reviewed the discharge summaries of all adult patients admitted to the medical intensive care units (ICUs) between January 2001 and December 2008 by searching for “Acute Respiratory Distress Syndrome,” “ARDS,” or “Acute Lung Injury,” and evaluated the charts identified to determine whether Berlin criteria for ARDS were met and mechanical ventilation was used

Summary

Introduction

Acute Respiratory Distress Syndrome (ARDS) is an acute inflammatory response of the lung to stressful pulmonary or extrapulmonary processes [1]. Because of the known high mortality rate of ARDS, many studies have examined risk factors associated with severity and mortality. Ese efforts have identified age, comorbidities, presence of multiorgan dysfunction, and lung disease severity as factors correlating with ARDS outcomes [2,3,4]. Higher RDW values indicate more variation in red blood cell volume [5]. Over the last few years, numerous studies have shown a relationship between higher RDW values and worse outcomes in different clinical conditions including coronary artery disease, acute kidney injury, and chronic obstructive lung disease [6,7,8]. An examination of whether RDW is predictive of ARDS outcomes has not been performed. Due to its availability in clinical settings, RDW values are attractive candidates for providing additional prognostic information about those with ARDS

Objectives

Methods

Results