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Predictors of mortality in ARDS patients referred to a tertiary care centre: a pilot study
Thomas Luecke1, Elke Muench, Harry Roth
1Department of Anesthesiology and Critical Care Medicine, University of Heidelberg, Faculty of Clinical Medicine, Hospital of Mannheim, Germany. thomas.luecke@anaes.ma.uni-heidelberg.de
Insights
Younger age and lower APACHE II scores predict survival in acute respiratory distress syndrome (ARDS) patients transferred to tertiary care. Increased positive end-expiratory pressure after transfer significantly reduces survival chances.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Respiratory Medicine
Background:
- Acute Respiratory Distress Syndrome (ARDS) is a severe lung condition requiring specialized care.
- Patients with progressive ARDS are often transferred to tertiary centers for advanced management.
- Identifying predictors of mortality in this population is crucial for improving outcomes.
Purpose of the Study:
- To identify parameters that predict intensive care unit (ICU) mortality in patients transferred with progressive ARDS.
- To evaluate the impact of initial clinical status and early changes in respiratory parameters on survival.
Main Methods:
- An observational pilot study included 94 patients transferred with progressive ARDS.
- Data collected included demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and respiratory parameters (PaO2/FiO2, PEEP, Murray score).
- Multivariate analysis was used to identify independent predictors of ICU mortality.
Main Results:
- Forty-one patients (43.6%) died in the ICU.
- Survivors were younger and had lower APACHE II scores, higher PaO2/FiO2 ratios, and lower positive end-expiratory pressure (PEEP) and Murray scores on admission.
- Multivariate analysis identified age and APACHE II score as significant predictors of mortality on admission.
- An increase in PEEP after transfer was associated with a significantly reduced chance of survival (Odds Ratio 2.40).
Conclusions:
- Age and APACHE II score are key predictors of mortality in transferred ARDS patients.
- Younger patients with lower APACHE II scores at admission have a better prognosis.
- A significant increase in PEEP after transfer is a strong negative predictor of survival, indicating treatment challenges.
Background And Objective:
In order to identify parameters predicting intensive care unit mortality in patients transferred to a specialized tertiary centre because of progressive acute respiratory distress syndrome, an observational pilot study was carried out involving 94 patients.
Methods And Results:
Forty-one patients (43.6%) died. Survival was defined as intensive care unit discharge. Survivors were younger (32.0 +/- 11.8 vs. 39.1 +/- 12.4 yr, P = 0.008), at admission they had a lower acute physiology and chronic health evaluation (APACHE) II score (21.7 +/- 5.4 vs. 25.4 +/- 5.2, P = 0.0009), higher PaO2/FiO2 (122 +/- 79 vs. 79 +/- 42 mmHg, P = 0.002), lower positive end-expiratory pressure (10.6 +/- 3.1 vs. 12.5 +/- 3.7 cmH2O, P = 0.02) and a lower Murray score (2.8 +/- 0.63 vs. 3.0 +/- 0.62, P = 0.04). No differences were observed for tidal volumes and peak inspiratory pressures. Days of hospitalization and mechanical ventilation prior to transferral were not related to survival. Multivariate analysis of variables assessed on admission detected only differences for age (P = 0.014) and APACHE II (P = 0.005). Odds ratio was 1.06 (95% confidence interval (CI): 1.013-1.119) for age and 1.21 (CI: 1.059-1.381) for APACHE II. Multivariate analysis of changes in respiratory parameters, APACHE II and Murray score during the first 3 days after transferral revealed a significant difference only for positive end-expiratory pressure (P < 0.008). Corresponding odds ratio was 2.40 (CI: 1.25-4.58) for an increase of 1 cmH2O/24 h.
Conclusion:
Age-related mortality in this small, but highly selected group of patients with established ARDS increased early in life even in a population with an overall mean age of 35.1 yr. APACHE II was the only clinical predictor for mortality on admission. The need for a substantial increase in positive end-expiratory pressure after transferral markedly reduced the chance to survive.
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