Early Identification of Patients at Risk of Acute Lung Injury Evaluation of Lung Injury Prediction Score in a Multicenter Cohort Study
Early Identification of Patients at Risk of Acute Lung Injury Evaluation of Lung Injury Prediction Score in a Multicenter Cohort Study
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DOI：
10.1164/rccm.201004-0549oc
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发表时间：
2011-02-15
影响因子：
24.7
通讯作者：
Malinchoc, Michael
中科院分区：
文献类型：
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作者：
Gajic, Ognien;Dabbagh, Ousama;Malinchoc, Michael
基本原理：准确、早期识别急性肺损伤（ALI）风险患者提供了测试和实施二级预防策略的机会。目的：确定风险患者发生ALI的频率和结局，并验证肺损伤预测评分（LIPS）。方法：在这项前瞻性多中心观察性队列研究中，在初始评估期间，从常规临床数据中确定了预测ALI发展的易感条件和风险因素。用受试者工作曲线下面积（AUC）评价模型的区分度。急性肺损伤死亡的风险调整后确定的严重程度的疾病和诱发conditions. Measures和主要结果：22家医院登记的5,584例患者的风险所有开发的中位数为2（四分位数范围1-4）天后，在377（6.8%，148只急性肺损伤，229成人呼吸窘迫综合征）患者的初步评估。急性肺损伤的发生率因诱发条件而异（从胰腺炎的3%到吸入烟雾后的26%）。LIPS可区分发生ALI的患者和未发生ALI的患者，AUC为0.80（95%置信区间，0.78-0.82）。当调整疾病的严重程度和诱发条件，发展的ALI增加了院内死亡的风险（比值比，4.1; 95%置信区间，2.9-5.7）。结论：ALI的发生根据诱发条件而变化，并进行独立的预后不良。使用常规可用的临床数据，LIPS识别出在其疾病过程早期具有ALI高风险的患者。该模型将提醒临床医生有关ALI的风险，并促进ALI预防策略的测试和实施。在www.clinicaltrials.gov注册的临床试验（NCT 00889772）。
Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies.Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS).Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions.Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk All developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80(95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7).Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772).