Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome.
Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000002001
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发表时间：
2016-12
影响因子：
8.8
通讯作者：
Gong MN
中科院分区：
文献类型：
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作者：
Soto GJ;Kor DJ;Park PK;Hou PC;Kaufman DA;Kim M;Yadav H;Teman N;Hsu MC;Shvilkina T;Grewal Y;De Aguirre M;Gunda S;Gajic O;Gong MN
肺损伤预测评分（LIPS）可识别急诊科（艾德）中有ARDS风险的患者，但尚未在非艾德住院患者中得到验证。我们的目的是评估LIPS是否识别出非ED住院患者在重症监护接触时发生ARDS的风险。回顾性研究。五个学术医疗中心。900例连续患者（≥18岁）在重症监护联系时至少有一个ARDS风险因素。没有。使用初始重症监护联系前12小时内的最差值计算LIPS。排除初次接触时患有ARDS的患者。124例（13.7%）患者在重症监护联系后中位数2天（IQR 2-3）发生ARDS。住院死亡率为22%，ARDS患者的住院死亡率明显高于非ARDS患者（48% vs. 18%，p<0.001）。LIPS增加与ARDS的发展（OR 1.31，95%CI 1.21-1.42）和ARDS或死亡的复合结局（OR 1.26，95%CI 1.18-1.34）显著相关。LIPS ≥ 4与ARDS的发生（OR 4.17，95%CI 2.26-7.72）、ARDS或死亡的复合结局（OR 2.43，95%CI 1.68-3.49）以及考虑死亡竞争风险后的ARDS（HR 3.71，95%CI 2.05-6.72）相关。对于ARDS发展，LIPS的AUROC为0.70，LIPS ≥ 4的敏感性为90%（仅漏诊10%的ARDS病例），特异性为31%，阳性预测值为17%，阴性预测值为95%。在非艾德住院患者队列中，LIPS和LIPS ≥ 4可以识别重症监护联系时ARDS和/或死亡风险增加的患者，但其表现不如原始艾德队列。
The lung injury prediction score (LIPS) identifies patients at risk for ARDS in the emergency department (ED) but it has not been validated in non-ED hospitalized patients. We aimed to evaluate whether LIPS identifies non-ED hospitalized patients at risk of developing ARDS at the time of critical care contact. Retrospective study. Five academic medical centers. Nine hundred consecutive patients (≥18 y/o) with at least one ARDS risk factor at the time of critical care contact. None. LIPS was calculated using the worst values within the 12 hours before initial critical care contact. Patients with ARDS at the time of initial contact were excluded. ARDS developed in 124 (13.7%) patients a median of 2 days (IQR 2–3) after critical care contact. Hospital mortality was 22% and was significantly higher in ARDS than non-ARDS patients (48% vs. 18%, p<0.001). Increasing LIPS was significantly associated with development of ARDS (OR 1.31, 95%CI 1.21–1.42) and the composite outcome of ARDS or death (OR 1.26, 95%CI 1.18–1.34). A LIPS ≥ 4 was associated with the development of ARDS (OR 4.17, 95%CI 2.26–7.72), composite outcome of ARDS or death (OR 2.43, 95%CI 1.68–3.49), and ARDS after accounting for the competing risk of death (HR 3.71, 95%CI 2.05–6.72). For ARDS development, the LIPS has an AUROC of 0.70 and a LIPS ≥ 4 has 90% sensitivity (misses only 10% of ARDS cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value. In a cohort of non-ED hospitalized patients, the LIPS and LIPS ≥ 4 can identify patients at increased risk of ARDS and/or death at the time of critical care contact but it does not perform as well as in the original ED cohort.