Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings
Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings
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DOI：
10.7326/0003-4819-141-6-200409210-00009
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发表时间：
2004-09-21
影响因子：
39.2
通讯作者：
Ríos, F
中科院分区：
文献类型：
--
作者：
Esteban, A;Fernández-Segoviano, P;Ríos, F
背景资料：急性呼吸窘迫综合征（ARDS）的美国-欧洲共识会议定义从未得到验证。目的：比较ARDS的临床标准与尸检结果。设计：尸检结果与从病历中回顾性提取的临床特征的独立比较。设置：三级内科-外科重症监护室。参与者：382例接受临床尸检的患者。测量：通过使用尸检时的弥漫性肺泡损伤作为参考标准，计算3个队列中临床标准的敏感性、特异性和似然比。3个队列为1）所有患者，2）有任何ARDS风险因素的患者，3）根据其肺或肺外风险因素分开的患者。结果：127例患者（33%）符合临床标准，112例（29%）有弥漫性肺泡损伤。在所有患者中，临床定义的敏感性为75%（95% CI，66%至82%），特异性为84%（CI，79%至88%）。在284例有危险因素的患者中，敏感性为76%（CI，67%~ 83%），特异性为75%（CI，68%~ 81%）。与有肺内危险因素的患者相比，有肺外危险因素的患者敏感性明显增高（61% vs. 85%; P = 0.009），特异性无统计学显著差异（69% vs. 78%; P > 0.2）。局限性：只有死亡并进行尸检的患者可以纳入本研究，因此这些结果可能不适用于不太严重的ARDS病例。在一系列尸检患者中，美欧共识会议对ARDS定义的准确性仅为中等。对于有肺外危险因素的患者，其定义比有肺内危险因素的患者更准确。
Background: The American-European Consensus Conference definition for the acute respiratory distress syndrome (ARDS) has never been validated.Objective: To compare clinical criteria for ARDS with autopsy findings.Design: independent comparison of autopsy findings with clinical characteristics retrospectively abstracted from medical records.Setting: Tertiary medical-surgical intensive care unit.Participants: 382 patients who underwent clinical autopsy.Measurements: Sensitivity, specificity, and likelihood ratios for clinical criteria were calculated in 3 cohorts by using diffuse alveolar damage at autopsy as the reference standard. The 3 cohorts were 1) all patients, 2) patients with any risk factor for ARDS, and 3) patients who were separated according to their pulmonary or extrapulmonary risk factors. Results: 127 patients (33%) met the clinical criteria, and 112 (29%) had diffuse alveolar damage. In all patients, the sensitivity of the clinical definition was 75% (95% Cl, 66% to 82%) and the specificity was 84% (Cl, 79% to 88%). In 284 patients with risk factors, the sensitivity was 76% (Cl, 67% to 83%) and the specificity was 75% (Cl, 68% to 81%). Compared with patients with pulmonary risk factors, patients with extrapulmonary risk factors had significantly higher sensitivity (61 % vs. 85%; P = 0.009) and the specificity did not statistically significantly differ (69% vs. 78%; P > 0.2).Limitations: Only patients who died and underwent autopsy could be included in this study, so these results may not apply to less severe cases of ARDS.Conclusions: In a series of autopsy patients, the accuracy of the American-European Consensus Conference definition of ARDS was only moderate. The definition was more accurate for patients with extrapulmonary risk factors than for patients with pulmonary risk factors.