Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

• Published in: Intensive care medicine 2017-03, Vol.43 (3), p.399-407
• Main Authors: Zhang, Ruyang, Wang, Zhaoxi, Tejera, Paula, Frank, Angela J., Wei, Yongyue, Su, Li, Zhu, Zhaozhong, Guo, Yichen, Chen, Feng, Bajwa, Ednan K., Thompson, B. Taylor, Christiani, David C.
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Aged; Analysis; Anesthesiology; Critical Care Medicine; Datasets; Emergency Medicine; Female; Germany; Health aspects; Humans; Intensive; Intensive care; Intensive Care Units; Logistic Models; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Mortality; Odds Ratio; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pneumonia; Proportional Hazards Models; Prospective Studies; Public health; Random Allocation; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Risk Factors; Sepsis; Severity of Illness Index; Survival Analysis; Time Factors; United Kingdom
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-016-4638-3

Purpose To evaluate the association between acute respiratory distress syndrome (ARDS) onset time and prognosis. Methods Patients with moderate to severe ARDS ( N  = 876) were randomly assigned into derivation ( N  = 520) and validation ( N  = 356) datasets. Both 28-day and 60-day survival times after ARDS onset were analyzed. A data-driven cutoff point between early- and late-onset ARDS was determined on the basis of mortality risk effects of onset times. We estimated the hazard ratio (HR) and odds ratio (OR) of late-onset ARDS using a multivariate Cox proportional hazards model of survival time and a multivariate logistic regression model of mortality rate, respectively. Results Late-onset ARDS, defined as onset over 48 h after intensive care unit (ICU) admission ( N  = 273, 31%), was associated with shorter 28-day survival time: HR = 2.24, 95% CI 1.48–3.39, P  = 1.24 × 10 −4 (derivation); HR = 2.16, 95% CI 1.33–3.51, P  = 1.95 × 10 −3 (validation); and HR = 2.00, 95% CI 1.47–2.72, P  = 1.10 × 10 −5 (combined dataset). Late-onset ARDS was also associated with shorter 60-day survival time: HR = 1.70, 95% CI 1.16–2.48, P  = 6.62 × 10 −3 (derivation); HR = 1.78, 95% CI 1.15–2.75, P  = 9.80 × 10 −3 (validation); and HR = 1.59, 95% CI 1.20–2.10, P  = 1.22 × 10 −3 (combined dataset). Meanwhile, late-onset ARDS was associated with higher 28-day mortality rate (OR = 1.46, 95% CI 1.04–2.06, P  = 0.0305) and 60-day mortality rate (OR = 1.44, 95% CI 1.03–2.02, P  = 0.0313). Conclusions Late-onset moderate to severe ARDS patients had both shorter survival time and higher mortality rate in 28-day and 60-day observations.