Predictor Of Acute Respiratory Distress Syndrome Research Articles

Predicting acute respiratory distress syndrome in influenza pneumonia patients using delta mean platelet volume

BackgroundPatients with influenza pneumonia are at high risk of rapid progression to acute respiratory distress syndrome (ARDS). Mean platelet volume (MPV), which reflects platelet size, is considered to be a crucial inflammatory marker. The study aim was to investigate the role of delta mean platelet volume (delta MPV) in predicting ARDS in patients with influenza pneumonia.MethodsThis retrospective study was conducted in a tertiary care centre in southern Thailand. Adult patients diagnosed with influenza pneumonia were enrolled from January 2015 to December 2020. Demographic data, laboratory investigations including delta MPV (MPV on day 2 minus MPV on day 1), management records, and clinical outcomes were collected for analysis. The study population was divided into two groups according to the development of ARDS.ResultsDuring the study, 1240 patients with laboratory-confirmed influenza were screened and 212 pneumonia patients were enrolled. Fifty-six patients (26.4%) met the diagnostic criteria for ARDS during hospitalization. Delta MPV was significantly higher in the ARDS group compared to that in the non-ARDS group (1.0 fL vs 0.2 fL, p < 0.001). Multivariable logistic regression revealed that delta MPV is an independent predictor of ARDS (OR 17.37; 95% CI 6.5–46.4; p < 0.001). Receiver operating characteristic curve analysis indicated a cut-off value of 0.7 fL for delta MPV (sensitivity 80.36%, specificity 80.77%) to predict ARDS in patients with influenza pneumonia.ConclusionsDelta MPV strongly predicts ARDS in influenza pneumonia patients. Implementation of delta MPV may be useful in identifying at-risk patients who will require intensive care and ARDS prevention.

Risk Factors and a Scoring System to Predict ARDS in Patients with COVID-19 Pneumonia in Korea: A Multicenter Cohort Study.

Predictive studies of acute respiratory distress syndrome (ARDS) in patients with coronavirus disease 2019 (COVID-19) are limited. In this study, the predictors of ARDS were investigated and a score that can predict progression to ARDS in patients with COVID-19 pneumonia was developed. All patients who were diagnosed with COVID-19 pneumonia between February 1, 2020, and May 15, 2020, at five university hospitals in Korea were enrolled. Their demographic, clinical, and epidemiological characteristics and the outcomes were collected using the World Health Organization COVID-19 Case Report Form. A logistic regression analysis was performed to determine the predictors for ARDS. The receiver operating characteristic (ROC) curves were constructed for the scoring model. Of the 166 patients with COVID-19 pneumonia, 37 (22.3%) patients developed ARDS. The areas under the curves for the infiltration on a chest X-ray, C-reactive protein, neutrophil/lymphocyte ratio, and age, for prediction of ARDS were 0.91, 0.90, 0.87, and 0.80, respectively (all P < 0.001). The COVID-19 ARDS Prediction Score (CAPS) was constructed using age (≥60 years old), C-reactive protein (≥5 mg/dL), and the infiltration on a chest X-ray (≥22%), with each predictor allocated 1 point. The area under the curve of COVID-19 ARDS prediction score (CAPS) for prediction of ARDS was 0.90 (95% CI 0.86–0.95; P < 0.001). It provided 100% sensitivity and 75% specificity when the CAPS score cutoff value was 2 points. CAPS, which consists of age, C-reactive protein, and the area of infiltration on a chest X-ray, was predictive of the development of ARDS in patients with COVID-19 pneumonia.

The Association between Mortality and the Oxygen Saturation and Fraction of Inhaled Oxygen in Patients Requiring Oxygen Therapy due to COVID-19-Associated Pneumonia.

BackgroundThe coronavirus disease (COVID-19) can manifest in a range of symptoms, including both asymptomatic systems which appear nearly non-existent to the patient, all the way to the development of acute respiratory distress syndrome (ARDS). Specifically, COVID-19–associated pneumonia develops into ARDS due to the rapid progression of hypoxia, and although arterial blood gas analysis can assist in halting this deterioration, the current environment provided by the COVID-19 pandemic, which has led to an overall lack of medical resources or equipment, has made it difficult to administer such tests in a widespread manner. As a result, this study was conducted in order to determine whether the levels of oxygen saturation (SpO2) and the fraction of inhaled oxygen (FiO2) (SF ratio) can also serve as predictors of ARDS and the patient’s risk of mortality.MethodsThis was a retrospective cohort study conducted from February 2020 to Mary 2020, with the study’s subjects consisting of COVID-19 pneumonia patients who had reached a state of deterioration that required the use of oxygen therapy. Of the 100 COVID-19 pneumonia cases, we compared 59 pneumonia patients who required oxygen therapy, divided into ARDS and non-ARDS pneumonia patients who required oxygen, and then investigated the different factors which affected their mortality.ResultsAt the time of admission, the ratios of SpO2, FiO2, and SF for the ARDS group differed significantly from those of the non-ARDS pneumonia support group who required oxygen (p<0.001). With respect to the predicting of the occurrence of ARDS, the SF ratio on admission and the SF ratio at exacerbation had an area under the curve which measured to be around 85.7% and 88.8% (p<0.001). Multivariate Cox regression analysis identified that the SF ratio at exacerbation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.846–0.991; p=0.029) and National Early Warning Score (NEWS) (HR, 1.277; 95% CI, 1.010–1.615; p=0.041) were significant predictors of mortality.ConclusionThe SF ratio on admission and the SF ratio at exacerbation were strong predictors of the occurrence of ARDS, and the SF ratio at exacerbation and NEWS held a significant effect on mortality.

Receptor for advanced glycation end-products and ARDS prediction: a multicentre observational study

Acute respiratory distress syndrome (ARDS) prediction remains challenging despite available clinical scores. To assess soluble receptor for advanced glycation end-products (sRAGE), a marker of lung epithelial injury, as a predictor of ARDS in a high-risk population, adult patients with at least one ARDS risk factor upon admission to participating intensive care units (ICUs) were enrolled in a multicentre, prospective study between June 2014 and January 2015. Plasma sRAGE and endogenous secretory RAGE (esRAGE) were measured at baseline (ICU admission) and 24 hours later (day one). Four AGER candidate single nucleotide polymorphisms (SNPs) were also assayed because of previous reports of functionality (rs1800625, rs1800624, rs3134940, and rs2070600). The primary outcome was ARDS development within seven days. Of 500 patients enrolled, 464 patients were analysed, and 59 developed ARDS by day seven. Higher baseline and day one plasma sRAGE, but not esRAGE, were independently associated with increased ARDS risk. AGER SNP rs2070600 (Ser/Ser) was associated with increased ARDS risk and higher plasma sRAGE in this cohort, although confirmatory studies are needed to assess the role of AGER SNPs in ARDS prediction. These findings suggest that among at-risk ICU patients, higher plasma sRAGE may identify those who are more likely to develop ARDS.

Clinical Significance and Prognostic Implications of Quantifying Pulmonary Contusion Volume in Patients with Blunt Chest Trauma

BackgroundPulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT).Material/MethodsBCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission. Data included patients’ demographics, mechanism of injury (MOI) and injury severity, associated injuries, CTCV, mechanical ventilation, complications, and mortality.ResultsA total of 226 BCT patients were identified to have PC with a mean age of 35.2 years. Motor vehicle crash (54.4%) and falls (16.4%) were the most frequent MOIs. Bilateral PC (61.5%) was more prevalent than right-sided (19.5%) and left-sided PC (19%). CTCV had a significant positive correlation with ISS; whereas, age and PaO2/FiO2 ratio showed a negative correlation (p<0.05 for all). The median CTCV was significantly higher in patients who developed in-hospital complications (p=0.02). A CTCV >20% was associated with increasedrisk of acute respiratory distress syndrome (ARDS), blood transfusion and prolonged mechanical ventilation. However, multiple linear regression analysis showed that CTCV alone was not an independent predictor of in-hospital outcomes. Presence of chest infection, CTCV, and Injury Severity Scores were predictors of ARDS.ConclusionsQuantifying pulmonary contusion volume could allow identification of patients at high-risk of ARDS. CTCV has a significant correlation with injury severity in patients with BCT. Further prospective studies are needed to address the validity of CTCV in the patients care.

Pathological finding of subclinical interstitial pneumonia as a predictor of postoperative acute respiratory distress syndrome after pulmonary resection

Post-surgical interstitial pneumonia (IP) is a part of postoperative acute respiratory distress syndrome (ARDS). Some cases of ARDS may be an acute exacerbation of idiopathic pulmonary fibrosis (IPF) that is generally not recognised as IPF prior to surgery. In this study, we evaluated IP on preoperative computed tomography (CT) and histopathological findings in patients who underwent thoracic surgery, and attempted to identify high-risk patients who might develop postoperative ARDS. A retrospective review of preoperative CT and histopathological examination was performed in 487 patients who underwent lobectomy for primary lung cancer at our institute. The incidence of ARDS was 2.05%, and histopathological finding of IP was the only predictor of ARDS (P = 0.038, odds ratio (OR) = 6.89). The incidence of IP on histopathological examination was 9.7% for all cases of lung cancer; and the incidence of ARDS in the IP-positive group (31.8%) was significantly different from that in the IP-negative group (1.5%) (P<0.05). However, in 85.7% of patients with ARDS, who were histologically IP-positive, IP was masked by emphysematous findings and thus not detected on preoperative CT. In this study, histopathological finding of IP was the only predictor of ARDS; however, it was difficult to identify preoperatively because emphysematous change was also present in the majority of cases, which masks the findings of IP on CT. If identification of the high-risk case of ARDS is insisted upon, screening the presence or absence of IP (e.g., just in the patients with emphysema or IP finding on CT) by histopathological examination, as the need arises, after surgery using resected lung might be one of the additional methods of identifying those at high risk of ARDS.

Hypertonic Resuscitation of Hypovolemic Shock After Blunt Trauma

The leading cause of late mortality after trauma is multiple organ failure syndrome, due to a dysfunctional inflammatory response early after injury. Preclinical studies demonstrate that hypertonicity alters the activation of inflammatory cells, leading to reduction in organ injury. The purpose of this study was to evaluate the effect of hypertonicity on organ injury after blunt trauma. Double-blind, randomized controlled trial from October 1, 2003, to August 31, 2005. Prehospital enrollment at a single level I trauma center. Patients older than 17 years with blunt trauma and prehospital hypotension (systolic blood pressure, </= 90 mm Hg). Treatment with 250 mL of 7.5% hypertonic saline and 6% dextran 70 (HSD) vs lactated Ringer solution (LRS). The primary end point was survival without acute respiratory distress syndrome (ARDS) at 28 days. Cox proportional hazards regression was used to adjust for confounding factors. A preplanned subset analysis was performed for patients requiring 10 U or more of packed red blood cells in the first 24 hours. A total of 209 patients were enrolled (110 in the HSD group and 99 in the LRS group). The study was stopped for futility after the second interim analysis. Intent-to-treat analysis demonstrated no significant difference in ARDS-free survival (hazard ratio, 1.01; 95% confidence interval, 0.63-1.60). There was improved ARDS-free survival in the subset (19% of the population) requiring 10 U or more of packed red blood cells (hazard ratio, 2.18; 95% confidence interval, 1.09-4.36). Although no significant difference in ARDS-free survival was demonstrated overall, there was benefit in the subgroup of patients requiring 10 U or more of packed red blood cells in the first 24 hours. Massive transfusion may be a better predictor of ARDS than prehospital hypotension. The use of HSD may offer maximum benefit in patients at highest risk of ARDS.