The UTAMI score: a chest x-ray-based tool for predicting ICU admission in ARDS of pneumonia patients

This study proposes and evaluates the Universal Thorax ARDS Modification Index (UTAMI), a new method based on chest x-ray findings, for rapid ICU admission prediction in pneumonia with ARDS. Clinical and laboratory variables are analyzed to find potential predictors.

A cross-sectional study at Fatmawati Central General Hospital (2022-2023) compared the diagnostic accuracy of UTAMI method against the gold standard for ARDS diagnosis; Berlin Definition. We analyzed 318 patients' data that were hospitalized for pneumonia. Clinical and laboratory predictors of ARDS were also analyzed.

Neutrophil levels, CRP, D-dimer, oxygen saturation, and respiratory rate can predict ARDS diagnosis according to the Berlin Definition. The patient cohort showed that those with moderate-severe ARDS were admitted to the ICU. With ARDS categorized as ARDS requiring ICU admission (ARDS ICU) and ARDS not requiring ICU admission, the UTAMI method requires only history of coronary artery disease (CAD), CRP, and oxygen saturation as key predictors. CRP was a predictor in both the Berlin Definition (PR 1.28) and the UTAMI method (PR 1.71). In the AUROC test, the Berlin Definition distinguished moderate-severe ARDS with 81.2% accuracy using chest radiographs, clinical and laboratory values. The UTAMI method, based solely on chest radiographs achieved 79.6% accuracy, showing fair discrimination against the gold standard.

UTAMI Score is a viable tool for predicting the risk of ARDS in pneumonia. Utilizing UTAMI method, ARDS can be predicted using only chest radiograph, making it easier for clinicians to be alerted earlier. Predicting ARDS ICU from UTAMI method requires only 3 variables; CAD comorbid, laboratory CRP and peripheral oxygen saturation.