Clinical epidemiology and mortality on patients with acute respiratory distress syndrome (ARDS) in Vietnam.

Luong Quoc Chinh,Yuji Fujikura,Do Ngoc Son,Nguyen Gia Binh,Dao Xuan Co,Dat Anh Nguyen,Dang Quoc Tuan,Koichiro Kudo,Nguyen Van Chi,Khuong Quoc Dai,Mai Duy Ton,Hiroyuki Nagase,Toshie Manabe,Pham The Thach,Andrea Coppadoro

doi:10.1371/journal.pone.0221114

Abstract

BackgroundThe clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam.MethodsWe conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age ≥18 years) who were admitted and diagnosed with ARDS during 2015–2017. Data on patients’ general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis.ResultsAmong 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO2/FiO2 on admission between non-survivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO2/FiO2 on day 3 [odds ratio (OR), 1.010; 95% confidence interval (CI), 1.003–1.017], length of stay in a local hospital before admission to the central hospital (OR, 1.122; 95% CI, 1.042–1.210) due to stable condition, and SOFA score on Day 1 (OR, 0.842; 95% CI, 0.708–1.002) were independent factors in patient survival.ConclusionsPatients with ARDS admitted the central tertiary hospital had severe illness and high mortality. Most patients were transferred from local hospitals. Improvements in human, medical, and sociological resources in local will contribute to reducing the mortality of ARDS in Vietnam.

Highlights

Acute respiratory distress syndrome (ARDS) is a type of acute diffuse lung injury characterized by an inciting inflammation event followed by hypoxemic respiratory failure [1]
Among 126 eligible patients with acute respiratory distress syndrome (ARDS) admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%)
91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and diagnosed with ARDS at the central hospital

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a type of acute diffuse lung injury characterized by an inciting inflammation event followed by hypoxemic respiratory failure [1]. Medical providers still have difficulties in caring for patients with ARDS in local settings owing to limited medical resources and a lack of advanced treatment strategies, such as extracorporeal membrane oxygenation, as well as physicians’ lower abilities to recognize ARDS in their patients. The initiation of treatment in patients with ARDS is often delayed, including the administration of mechanical ventilation (MV) [12] Under these conditions, the prognosis of ARDS in Vietnam might differ from that of other countries, regardless of income level. Understanding the country-specific etiologies and the disease risk and prognosis of ARDS are crucial for reducing mortality in Vietnam, as well as in other countries that face challenges in clinical practice owing to limited medical resources. The clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam

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