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Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study

BACKGROUND: Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or wit...

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Autores principales: de Prost, Nicolas, Pham, Tài, Carteaux, Guillaume, Mekontso Dessap, Armand, Brun-Buisson, Christian, Fan, Eddy, Bellani, Giacomo, Laffey, John, Mercat, Alain, Brochard, Laurent, Maître, Bernard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476531/
https://www.ncbi.nlm.nih.gov/pubmed/28631088
http://dx.doi.org/10.1186/s13613-017-0281-6
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author de Prost, Nicolas
Pham, Tài
Carteaux, Guillaume
Mekontso Dessap, Armand
Brun-Buisson, Christian
Fan, Eddy
Bellani, Giacomo
Laffey, John
Mercat, Alain
Brochard, Laurent
Maître, Bernard
author_facet de Prost, Nicolas
Pham, Tài
Carteaux, Guillaume
Mekontso Dessap, Armand
Brun-Buisson, Christian
Fan, Eddy
Bellani, Giacomo
Laffey, John
Mercat, Alain
Brochard, Laurent
Maître, Bernard
author_sort de Prost, Nicolas
collection PubMed
description BACKGROUND: Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or without risk factors, the impact on hospital mortality, and to assess the diagnostic work-up performed. The current study is an ancillary analysis of an international, multicenter, prospective cohort study (the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure, LUNG SAFE). Patients meeting ARDS criteria within 2 days of acute hypoxemic respiratory failure onset were included in the study and categorized as having risk factors or not. Outcomes were compared using propensity score matching. RESULTS: Among 2813 patients, 234 (8.3% [7.3–9.3]) had no ARDS risk factor identified. These were older, had more frequent chronic diseases and presented with less severe SOFA and non-pulmonary SOFA scores (p < 0.001). Compared to other ARDS, CT scan (32.1 vs 23.9%, p < 0.001) and open lung biopsy (2.6 vs 0.2%, p < 0.001) were slightly more frequent but left heart filling pressures assessment was not (69.4 vs 68.4%, p > 0.99). Among ARDS with no risk factor, 45 patients (19.2%) had a specific diagnosis made. As compared to others, patients having ARDS with no risk factor had a lower ICU but not hospital mortality (34.6 vs 40.0%; p = 0.12). A matched cohort analysis confirmed the lack of significant difference in mortality. CONCLUSION: Eight percent of ARDS patients have no identified risk factor, 80% of whom have no etiological diagnosis made. The outcome of ARDS with no risk factor was comparable to other ARDS but few had a comprehensive diagnostic work-up, potentially leading to missed curable diseases. Trial registration clinicaltrials.gov Identifier: NCT02010073 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0281-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-54765312017-07-06 Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study de Prost, Nicolas Pham, Tài Carteaux, Guillaume Mekontso Dessap, Armand Brun-Buisson, Christian Fan, Eddy Bellani, Giacomo Laffey, John Mercat, Alain Brochard, Laurent Maître, Bernard Ann Intensive Care Research BACKGROUND: Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more “common” risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or without risk factors, the impact on hospital mortality, and to assess the diagnostic work-up performed. The current study is an ancillary analysis of an international, multicenter, prospective cohort study (the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure, LUNG SAFE). Patients meeting ARDS criteria within 2 days of acute hypoxemic respiratory failure onset were included in the study and categorized as having risk factors or not. Outcomes were compared using propensity score matching. RESULTS: Among 2813 patients, 234 (8.3% [7.3–9.3]) had no ARDS risk factor identified. These were older, had more frequent chronic diseases and presented with less severe SOFA and non-pulmonary SOFA scores (p < 0.001). Compared to other ARDS, CT scan (32.1 vs 23.9%, p < 0.001) and open lung biopsy (2.6 vs 0.2%, p < 0.001) were slightly more frequent but left heart filling pressures assessment was not (69.4 vs 68.4%, p > 0.99). Among ARDS with no risk factor, 45 patients (19.2%) had a specific diagnosis made. As compared to others, patients having ARDS with no risk factor had a lower ICU but not hospital mortality (34.6 vs 40.0%; p = 0.12). A matched cohort analysis confirmed the lack of significant difference in mortality. CONCLUSION: Eight percent of ARDS patients have no identified risk factor, 80% of whom have no etiological diagnosis made. The outcome of ARDS with no risk factor was comparable to other ARDS but few had a comprehensive diagnostic work-up, potentially leading to missed curable diseases. Trial registration clinicaltrials.gov Identifier: NCT02010073 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13613-017-0281-6) contains supplementary material, which is available to authorized users. Springer International Publishing 2017-06-19 /pmc/articles/PMC5476531/ /pubmed/28631088 http://dx.doi.org/10.1186/s13613-017-0281-6 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research
de Prost, Nicolas
Pham, Tài
Carteaux, Guillaume
Mekontso Dessap, Armand
Brun-Buisson, Christian
Fan, Eddy
Bellani, Giacomo
Laffey, John
Mercat, Alain
Brochard, Laurent
Maître, Bernard
Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title_full Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title_fullStr Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title_full_unstemmed Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title_short Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
title_sort etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476531/
https://www.ncbi.nlm.nih.gov/pubmed/28631088
http://dx.doi.org/10.1186/s13613-017-0281-6
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