Relationship between early progression and prognosis of acute respiratory distress syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WENG Bingbing ^1,3 , HUANG Xu ^2,3 , WU Dawei ⁴ , LU Haining ⁴ , WANG Daoxin ⁵ , DENG Wang ⁵ , SUN Tongwen ⁶ , XING Lihua ⁷ , LIU Shaohua ⁷ , WANG Shilei ⁷ ,  ZHAN Qingyuan ^2,3

1. Graduate School of Beijing University of Chinese Medicine, Beijing 100029, P. R. China;
2. Graduate School of Peking Union Medical College, Beijing 100730, P. R. China;
3. National Clinical Research Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, P. R. China;
4. Department of Critical Care Medicine, Qilu Hospital of Shandong University (Qingdao), Qingdao, Shandong 250023, P. R. China;
5. Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;
6. Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China;
7. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China;

Corresponding author：

ZHAN Qingyuan, Email: drzhanqy@163.com

Keywords：

Acute respiratory distress syndrome; classification; risk factor

DOI：

10.7507/1671-6205.202309057

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Objective To investigate the risk factors for early progression in patients with acute respiratory distress syndrome (ARDS), and to provide a reference for early detection and intervention of high-risk patients with ARDS progression. Methods Data from multicenter mechanically ventilated patients with mild to moderate ARDS were retrospectively analyzed. According to the severity grade of 72 h ARDS, the patients were divided into an early progressive group and a non-progressive group. Chi-square test was used to compare the risk factors of ARDS patients and the prognosis of the two groups were analyzed by Logistic regression. Results A total of 355 patients with mild to moderate ARDS were included in invasive mechanical ventilation, of which 97 patients (27.3%) progressed after 72 hours. 78.4% were female in the progressive group and 64.0% were female in the non-progressive group. Compared with the non-progressive group, the patients with ARDS in the progressive group had shorter 28-day no mechanical ventilation, higher ICU mortality, and lower survival rate at 30 days and 60 days（P<0.05）, but there was no significant difference in the length of ICU stay between the two groups (P>0.05). Univariate and multivariate regression analysis showed that the patients with ARDS in the progressive group had lower baseline oxygenation index (OR=0.979, 95%CI 0.961 - 0.986, P<0.01), higher peak airway pressure (OR=1.068, 95%CI 1.017 - 1.121, P<0.01), higher lactate level (OR=1.224, 95%CI 1.057 - 1.417, P<0.01), higher tidal volume (OR=1.159, 95%CI 1.002 - 1.341, P<0.05), higher age (OR=1.373, 95%CI 1.051 - 1.082, P<0.01), and more male patients (OR=2.583, 95%CI 1.336 - 4.995, P<0.05). Conclusions Early progression is common in mild to moderate ARDS patients with mechanical ventilation. The progressive group has shorter duration of 28 days without mechanical ventilation, higher ICU mortality and lower 30-day and 60-day survival rate than the non-progressive group. Male, low baseline oxygenation index levels, high peak airway pressure, tidal volume, lactate levels, and higher age are risk factors for early progression in patients with mild to moderate ARDS.

Citation： WENG Bingbing, HUANG Xu, WU Dawei, LU Haining, WANG Daoxin, DENG Wang, SUN Tongwen, XING Lihua, LIU Shaohua, WANG Shilei, ZHAN Qingyuan. Relationship between early progression and prognosis of acute respiratory distress syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(1): 37-42. doi: 10.7507/1671-6205.202309057 Copy

1.	Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
2.	Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
3.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
4.	Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA, 2016, 315(8): 788-800.
5.	Wong JJ, Loh TF, Testoni D, et al. Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality. Front Pediatr, 2014, 2: 78.
6.	Estenssoro E, Dubin A, Laffaire E, et al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med, 2002, 30(11): 2450-2456.
7.	Huang X, Xu L, Pei Y, et al. The association between oxygenation status at 24 h after diagnosis of pulmonary acute respiratory distress syndrome and the 30-day mortality among pediatric oncological patients. Front Pediatr, 2022, 10: 805264.
8.	Brun-Buisson C, Minelli C, Bertolini G, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med, 2004, 30(1): 51-61.
9.	谭宝玲. 氧合指数与血管外肺水指数的动态变化对急性呼吸窘迫综合征患者预后的判断价值. 中国现代医生, 2018, 56(1): 1-3.
10.	Moss M, Mannino DM. Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979-1996). Crit Care Med, 2002, 30(8): 1679-1685.
11.	Kasotakis G, Stanfield B, Haines K, et al. Acute respiratory distress syndrome (ARDS) after trauma: improving incidence, but increasing mortality. J Crit Care, 2021, 64: 213-218.
12.	Vahdatpour CA, De Young S, Jaber JF, et al. Clinical characteristics and outcomes of COVID-19 acute respiratory distress syndrome (ARDS) survivors in early pandemic: a single healthcare system retrospective study. Cureus, 2022, 14(7): e26801.
13.	McNicholas BA, Madotto F, Pham T, et al. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J, 2019, 54(4): 1900609.
14.	崔金英, 王铁华, 刘壮, 等. 北京地区急性呼吸窘迫综合征患者死亡相关因素分析. 华中科技大学学报(医学版), 2016, 45(4): 445-449.
15.	Gee MH, Gottlieb JE, Albertine KH, et al. Physiology of aging related to outcome in the adult respiratory distress syndrome. J Appl Physiol (1985), 1990, 69(3): 822-829.
16.	Sevransky JE, Haponik EF. Respiratory failure in elderly patients. Clin Geriatr Med, 2003, 19(1): 205-224.
17.	Eachempati SR, Hydo LJ, Shou J, et al. Outcomes of acute respiratory distress syndrome (ARDS) in elderly patients. J Trauma, 2007, 63(2): 344-350.
18.	El-Haddad H, Jang H, Chen W, et al. The effect of demographics and patient location on the outcome of patients with acute respiratory distress syndrome. Ann Thorac Med, 2017, 12(1): 17-24.
19.	Suchyta MR, Clemmer TP, Elliott CG, et al. Increased mortality of older patients with acute respiratory distress syndrome. Chest, 1997, 111(5): 1334-1339.
20.	Cunha MCA, Schardong J, Righi NC, et al. Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: a multicenter cohort study. Clinics (Sao Paulo), 2023, 78: 100180.
21.	Schultz MJ, van Oosten PJ, Hol L. Mortality among elderly patients with COVID-19 ARDS-age still does matter. Pulmonology, 2023, 29(5): 353-355.
22.	Kamo T, Tasaka S, Suzuki T, et al. Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients. BMC Pulm Med, 2019, 19(1): 37.
23.	Masyuk M, Wernly B, Lichtenauer M, et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med, 2019, 45(1): 55-61.
24.	Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med, 2004, 32(8): 1637-1642.
25.	Jiang Z, Zhang Z, Sun Q, et al. Dynamic evaluation of the pulmonary protective effects of prone position ventilation via respiratory mechanics for patients with moderate to severe acute respiratory distress syndrome. J Thorac Dis, 2022, 14(8): 2757-2770.
26.	Mallory P, Cheifetz I. A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Rev Respir Med, 2020, 14(3): 307-315.
27.	岳伟岗, 蒋由飞, 袁鹏等. 气道压力释放通气对急性呼吸窘迫综合征患者住院病死率影响的累积Meta分析. 中国循证医学杂志, 2023, 23(5): 517-521.
28.	中华医学会呼吸病学分会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南(试行). 中华医学杂志, 2016, 96(6): 404-424.
29.	Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med, 1998, 338(6): 347-354.
30.	Villar J, Kacmarek RM, Pérez-Méndez L, et al. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med, 2006, 34(5): 1311-1318.

1. Ashbaugh DG, Bigelow DB, Petty TL, et al. Acute respiratory distress in adults. Lancet, 1967, 2(7511): 319-323.
2. Bernard GR, Artigas A, Brigham KL, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
3. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA, 2012, 307(23): 2526-2533.
4. Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA, 2016, 315(8): 788-800.
5. Wong JJ, Loh TF, Testoni D, et al. Epidemiology of pediatric acute respiratory distress syndrome in singapore: risk factors and predictive respiratory indices for mortality. Front Pediatr, 2014, 2: 78.
6. Estenssoro E, Dubin A, Laffaire E, et al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med, 2002, 30(11): 2450-2456.
7. Huang X, Xu L, Pei Y, et al. The association between oxygenation status at 24 h after diagnosis of pulmonary acute respiratory distress syndrome and the 30-day mortality among pediatric oncological patients. Front Pediatr, 2022, 10: 805264.
8. Brun-Buisson C, Minelli C, Bertolini G, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med, 2004, 30(1): 51-61.
9. 谭宝玲. 氧合指数与血管外肺水指数的动态变化对急性呼吸窘迫综合征患者预后的判断价值. 中国现代医生, 2018, 56(1): 1-3.
10. Moss M, Mannino DM. Race and gender differences in acute respiratory distress syndrome deaths in the United States: an analysis of multiple-cause mortality data (1979-1996). Crit Care Med, 2002, 30(8): 1679-1685.
11. Kasotakis G, Stanfield B, Haines K, et al. Acute respiratory distress syndrome (ARDS) after trauma: improving incidence, but increasing mortality. J Crit Care, 2021, 64: 213-218.
12. Vahdatpour CA, De Young S, Jaber JF, et al. Clinical characteristics and outcomes of COVID-19 acute respiratory distress syndrome (ARDS) survivors in early pandemic: a single healthcare system retrospective study. Cureus, 2022, 14(7): e26801.
13. McNicholas BA, Madotto F, Pham T, et al. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J, 2019, 54(4): 1900609.
14. 崔金英, 王铁华, 刘壮, 等. 北京地区急性呼吸窘迫综合征患者死亡相关因素分析. 华中科技大学学报(医学版), 2016, 45(4): 445-449.
15. Gee MH, Gottlieb JE, Albertine KH, et al. Physiology of aging related to outcome in the adult respiratory distress syndrome. J Appl Physiol (1985), 1990, 69(3): 822-829.
16. Sevransky JE, Haponik EF. Respiratory failure in elderly patients. Clin Geriatr Med, 2003, 19(1): 205-224.
17. Eachempati SR, Hydo LJ, Shou J, et al. Outcomes of acute respiratory distress syndrome (ARDS) in elderly patients. J Trauma, 2007, 63(2): 344-350.
18. El-Haddad H, Jang H, Chen W, et al. The effect of demographics and patient location on the outcome of patients with acute respiratory distress syndrome. Ann Thorac Med, 2017, 12(1): 17-24.
19. Suchyta MR, Clemmer TP, Elliott CG, et al. Increased mortality of older patients with acute respiratory distress syndrome. Chest, 1997, 111(5): 1334-1339.
20. Cunha MCA, Schardong J, Righi NC, et al. Aging-related predictive factors for oxygenation improvement and mortality in COVID-19 and acute respiratory distress syndrome (ARDS) patients exposed to prone position: a multicenter cohort study. Clinics (Sao Paulo), 2023, 78: 100180.
21. Schultz MJ, van Oosten PJ, Hol L. Mortality among elderly patients with COVID-19 ARDS-age still does matter. Pulmonology, 2023, 29(5): 353-355.
22. Kamo T, Tasaka S, Suzuki T, et al. Prognostic values of the Berlin definition criteria, blood lactate level, and fibroproliferative changes on high-resolution computed tomography in ARDS patients. BMC Pulm Med, 2019, 19(1): 37.
23. Masyuk M, Wernly B, Lichtenauer M, et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med, 2019, 45(1): 55-61.
24. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med, 2004, 32(8): 1637-1642.
25. Jiang Z, Zhang Z, Sun Q, et al. Dynamic evaluation of the pulmonary protective effects of prone position ventilation via respiratory mechanics for patients with moderate to severe acute respiratory distress syndrome. J Thorac Dis, 2022, 14(8): 2757-2770.
26. Mallory P, Cheifetz I. A comprehensive review of the use and understanding of airway pressure release ventilation. Expert Rev Respir Med, 2020, 14(3): 307-315.
27. 岳伟岗, 蒋由飞, 袁鹏等. 气道压力释放通气对急性呼吸窘迫综合征患者住院病死率影响的累积Meta分析. 中国循证医学杂志, 2023, 23(5): 517-521.
28. 中华医学会呼吸病学分会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南(试行). 中华医学杂志, 2016, 96(6): 404-424.
29. Amato MB, Barbas CS, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med, 1998, 338(6): 347-354.
30. Villar J, Kacmarek RM, Pérez-Méndez L, et al. A high positive end-expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized, controlled trial. Crit Care Med, 2006, 34(5): 1311-1318.

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