Early identification of patients at risk of acute lung injury: Evaluation of lung injury prediction score in a multicenter cohort study
Date
2011-02
Journal Title
Journal ISSN
Volume Title
Publisher
American Thoracic Society
Abstract
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.
Description
Keywords
General & internal medicine, Respiratory system, Respiratory distress syndrome, Adult, Prevention, Prediction model, Acute respiratory failure, Respiratory-distress-syndrome, Community-acquired pneumonia, Intensive-care-unit, Consensus conference, Clinical predictors, Ventilator settings, Acute-pancreatitis, Relevant outcomes, Severity scores, Validation
Citation
Gajic, O. vd. (2011). "Early identification of patients at risk of acute lung injury: Evaluation of lung injury prediction score in a multicenter cohort study". American Journal of Respiratory and Critical Care Medicine, 183(4), 462-470.