Survival predictor in patients with acute respiratory distress syndrome and diffuse alveolar damage undergoing open lung biopsy.

Kuo-Chin Kao,Chih-Hao Chang,Chung-Chi Huang,Li-Chung Chiu,Chen-Yiu Hung,Han-Chung Hu,Gernot Zissel

doi:10.1371/journal.pone.0180018

Kuo-Chin Kao, Chih-Hao Chang + Show 5 more

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https://doi.org/10.1371/journal.pone.0180018

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Journal: PloS one	Publication Date: Jul 5, 2017
Citations: 8	License type: CC BY 4.0

Affiliation: Chang Gung University, Chang Gung Memorial Hospital

Abstract

BackgroundDiffuse alveolar damage (DAD) is a typical pathological finding of open lung biopsies in patients with acute respiratory distress syndrome (ARDS). Patients with ARDS and DAD have been reported to have a poorer prognosis than those without DAD. The aim of this study was to investigate the survival predictors in patients with ARDS and DAD.MethodsWe retrospectively reviewed all ARDS patients who underwent an open lung biopsy which showed evidence of DAD from January 2006 to June 2015 at Chang Gung Memorial Hospital. Clinical data including baseline characteristics, medication, and survival outcomes were analyzed.ResultsA total of 64 ARDS patients with DAD were eligible for analysis and divided into known etiology (n = 17, 26.6%) and unknown etiology groups (n = 47, 73.4%). There was no significant difference in hospital mortality rate between the two groups (71.9% vs. 70.6%, p = 0.890). Univariate logistic regression analysis revealed that sequential organ failure assessment (SOFA) score at the time of a diagnosis of ARDS, and SOFA score, PaO2/FiO2 ratio, and positive end expiratory pressure level when the biopsy was performed were associated with hospital mortality. Multivariate analysis showed that the SOFA score on the day of the biopsy was an independent predictor of hospital mortality (odds ratio 1.413, 95% confidence interval 1.127–1.772; p = 0.03). There were no significant differences in the use, dose, duration and timing from ARDS to glucocorticoid therapy between the survivors and nonsurvivors.ConclusionFor selected ARDS patients who underwent an open lung biopsy with pathological DAD, SOFA score was an independent predictor of hospital mortality.

Highlights

Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS) and is characterized by hyaline membranes, lung edema, inflammation, hemorrhage and alveolar epithelial cell damage [1,2]
A total of 64 ARDS patients with DAD were eligible for analysis and divided into known etiology (n = 17, 26.6%) and unknown etiology groups (n = 47, 73.4%)
Univariate logistic regression analysis revealed that sequential organ failure assessment (SOFA) score at the time of a diagnosis of ARDS, and SOFA score, PaO2/FiO2 ratio, and positive end expiratory pressure level when the biopsy was performed were associated with hospital mortality

Summary

Introduction

Diffuse alveolar damage (DAD) is the pathological hallmark of acute respiratory distress syndrome (ARDS) and is characterized by hyaline membranes, lung edema, inflammation, hemorrhage and alveolar epithelial cell damage [1,2]. DAD is not included in the Berlin definition of ARDS because an open lung biopsy (OLB) may be associated with an increased risk of complications [3]. DAD has been reported in 56%-58% of ARDS patients undergoing an OLB and in 33%-45% of those with autopsy examinations [4,5,6,7]. The presence of DAD in ARDS patients has been reported to be associated with a greater severity of disease and to be an independent risk factor for mortality [5,7]. A recent meta-analysis found that ARDS patients with DAD were associated with a higher risk of mortality than those without DAD [8]. Diffuse alveolar damage (DAD) is a typical pathological finding of open lung biopsies in patients with acute respiratory distress syndrome (ARDS).

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