Stratification for Identification of Prognostic Categories In the Acute RESpiratory Distress Syndrome (SPIRES) Score

Area of Science:

• Critical Care Medicine
• Respiratory Medicine
• Biostatistics and Epidemiology

Background:

• Acute respiratory distress syndrome (ARDS) is a severe lung condition with high ICU mortality.
• Early risk stratification is crucial for optimizing patient management and clinical trial enrollment.
• Existing scoring systems may not adequately predict outcomes in ARDS patients.

Purpose of the Study:

• To develop and validate a novel scoring model, the Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score (SPROTI), for predicting intensive care unit (ICU) death in ARDS patients.
• To stratify ARDS patients into distinct prognostic categories.
• To identify patients for therapeutic trials based on predicted risk.

Main Methods:

• Development and validation study using clinical data from four prospective, multicenter, observational cohorts.
• Logistic regression, bootstrapping, and internal-external validation were employed.
• The SPROTI score incorporates age, extrapulmonary organ failures, end-inspiratory plateau pressure, and Pao2/Fio2 ratio within 24 hours of ARDS diagnosis.

Main Results:

• The SPROTI model demonstrated strong predictive accuracy with a pooled area under the receiver operating characteristic curve (AUC) of 0.860 across validations.
• External validation in a separate cohort confirmed the model's robustness (AUC = 0.870).
• SPROTI effectively stratified patients into three prognostic classes and outperformed existing scores (APACHE II, SOFA) and Pao2/Fio2 ratios in predicting ICU mortality.

Conclusions:

• The SPROTI score offers a reliable method for early risk stratification of ARDS patients.
• This tool can aid in identifying high-risk individuals for closer monitoring and targeted therapies.
• SPROTI facilitates the selection of appropriate patient cohorts for clinical trials, potentially accelerating therapeutic advancements.