The evolution of radiographic edema in ARDS and its association with clinical outcomes: A prospective cohort study in adult patients
The evolution of radiographic edema in ARDS and its association with clinical outcomes: A prospective cohort study in adult patients
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DOI：
10.1016/j.jcrc.2020.01.012
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发表时间：
2020-04-01
影响因子：
3.7
通讯作者：
Kitsios, Georgios D.
中科院分区：
文献类型：
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作者：
Kotok, Daniel;Yang, Libing;Kitsios, Georgios D.
目的：探讨急性呼吸窘迫综合征(ARDS)患者胸部X线片(CXR)所见的胸片水肿的纵向演变及其与预后生物标志物、ARDS亚型和转归的关系。材料和方法：我们在插管当天和插管后10天内使用肺水肿放射学评分(RAE)对ARDS或心源性肺水肿(对照组)患者的CXR进行了定量研究。结果：Rale评分具有良好的评价者间一致性(r=0.83p<；0.0001)，其中急性呼吸窘迫综合征患者(n=108)的Rale评分高于对照组(n=21，p=0.01)。ARDS患者的基线Rale评分与糖基化终产物受体(RAGE)水平呈正相关(p<；0.05)。基线罗音评分不能预测30天或90天的存活率。持续较高的罗音评分与较长时间的机械通气相关(p=0.002)。结论：罗音评分易于实施，评定者间具有较高的可靠性。纵向罗音评分似乎是跟踪ARDS患者放射学水肿演变的一种可重复性的方法，并有可能预测长期机械通气的需要。(C)2020 Elsevier Inc.保留所有权利。
Purpose: To assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.Materials and methods: We quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.Results: The RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002).Conclusions: The RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation. (C) 2020 Elsevier Inc. All rights reserved.