Clinical predictors of and mortality in acute respiratory distress syndrome

Potential role of red cell transfusion

Michelle Ng Gong, B. Taylor Thompson, Paige Williams, Lucille Pothier, Paul D. Boyce, David C. Christiani

Research output: Contribution to journalArticle

318 Citations (Scopus)

Abstract

Objective: Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS risk and mortality including the role of red cell transfusion. Design: Observational prospective cohort. Setting: Intensive care unit of Massachusetts General Hospital. Patients: We studied 688 patients with sepsis, trauma, aspiration, and hypertransfusion. Interventions: None. Measurements and Main Results: Two hundred twenty-one (32%) subjects developed ARDS with a 60-day mortality rate of 46%. Significant predictors for ARDS on multivariate analyses included trauma (adjusted odds ratio [ORadj] 0.22,95% confidence interval [Cl] 0.09-0.53), diabetes (ORadj 0.58, 95% Cl 0.36-0.92), direct pulmonary injury (ORadj 3.78, 95% Cl 2.45-5.81), hematologic failure (ORadj 1.84, 95% Cl 1.05-3.21), transfer from another hospital (ORadj 2.08, 95% Cl 1.33-3.25), respiratory rate >33 breaths/min (ORadj 2.39, 95% Cl 1.51-3.78), hematocrit >37.5% (ORadj 1.77, 95% Cl 1.14-2.77), arterial pH <7.33 (ORadj 2.00, 95% Cl 1.31-3.05), and albumin ≤2.3 g/dL (ORadj 1.80, 95% Cl 1.18-2.73). Packed red blood cell transfusion was associated with ARDS (ORadj 1.52, 95% Cl 1.00-2.31, p = .05). Significant predictors for mortality in ARDS included age (ORadj 1.96, 95% Cl 1.50-2.53), Acute Physiology and Chronic Health Evaluation III score (ORadj 1.78, 95% Cl 1.16-2.73), trauma (ORadj 0.075, 95% Cl 0.006-0.96), corticosteroids before ARDS (ORadj 4.65, 95% Cl 1.47-14.7), and arterial pH <7.22 (ORadj 2.32, 95% Cl 1.02-5.25). Packed red blood cell transfusions were associated with increased mortality in ARDS (ORadj 1.10 per unit transfused; 95% Cl 1.04-1.17) with a significant dose-dependent response (p = .02). Conclusions: Important predictors for the development of and mortality in ARDS were identified. Packed red blood cell transfusion was associated with an increased development of and increased mortality in ARDS.

Original languageEnglish (US)
Pages (from-to)1191-1198
Number of pages8
JournalCritical Care Medicine
Volume33
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

Fingerprint

Adult Respiratory Distress Syndrome
Mortality
Erythrocyte Transfusion
Intensive Care Units
Wounds and Injuries
APACHE
Lung Injury
Respiratory Rate
Hematocrit
General Hospitals
Albumins
Sepsis
Adrenal Cortex Hormones
Multivariate Analysis
Odds Ratio
Prospective Studies
Confidence Intervals

Keywords

  • Acute lung injury
  • Acute respiratory distress syndrome
  • Mortality
  • Respiratory failure
  • Transfusion

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Clinical predictors of and mortality in acute respiratory distress syndrome : Potential role of red cell transfusion. / Gong, Michelle Ng; Thompson, B. Taylor; Williams, Paige; Pothier, Lucille; Boyce, Paul D.; Christiani, David C.

In: Critical Care Medicine, Vol. 33, No. 6, 06.2005, p. 1191-1198.

Research output: Contribution to journalArticle

Gong, Michelle Ng ; Thompson, B. Taylor ; Williams, Paige ; Pothier, Lucille ; Boyce, Paul D. ; Christiani, David C. / Clinical predictors of and mortality in acute respiratory distress syndrome : Potential role of red cell transfusion. In: Critical Care Medicine. 2005 ; Vol. 33, No. 6. pp. 1191-1198.
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abstract = "Objective: Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS risk and mortality including the role of red cell transfusion. Design: Observational prospective cohort. Setting: Intensive care unit of Massachusetts General Hospital. Patients: We studied 688 patients with sepsis, trauma, aspiration, and hypertransfusion. Interventions: None. Measurements and Main Results: Two hundred twenty-one (32{\%}) subjects developed ARDS with a 60-day mortality rate of 46{\%}. Significant predictors for ARDS on multivariate analyses included trauma (adjusted odds ratio [ORadj] 0.22,95{\%} confidence interval [Cl] 0.09-0.53), diabetes (ORadj 0.58, 95{\%} Cl 0.36-0.92), direct pulmonary injury (ORadj 3.78, 95{\%} Cl 2.45-5.81), hematologic failure (ORadj 1.84, 95{\%} Cl 1.05-3.21), transfer from another hospital (ORadj 2.08, 95{\%} Cl 1.33-3.25), respiratory rate >33 breaths/min (ORadj 2.39, 95{\%} Cl 1.51-3.78), hematocrit >37.5{\%} (ORadj 1.77, 95{\%} Cl 1.14-2.77), arterial pH <7.33 (ORadj 2.00, 95{\%} Cl 1.31-3.05), and albumin ≤2.3 g/dL (ORadj 1.80, 95{\%} Cl 1.18-2.73). Packed red blood cell transfusion was associated with ARDS (ORadj 1.52, 95{\%} Cl 1.00-2.31, p = .05). Significant predictors for mortality in ARDS included age (ORadj 1.96, 95{\%} Cl 1.50-2.53), Acute Physiology and Chronic Health Evaluation III score (ORadj 1.78, 95{\%} Cl 1.16-2.73), trauma (ORadj 0.075, 95{\%} Cl 0.006-0.96), corticosteroids before ARDS (ORadj 4.65, 95{\%} Cl 1.47-14.7), and arterial pH <7.22 (ORadj 2.32, 95{\%} Cl 1.02-5.25). Packed red blood cell transfusions were associated with increased mortality in ARDS (ORadj 1.10 per unit transfused; 95{\%} Cl 1.04-1.17) with a significant dose-dependent response (p = .02). Conclusions: Important predictors for the development of and mortality in ARDS were identified. Packed red blood cell transfusion was associated with an increased development of and increased mortality in ARDS.",
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TY - JOUR

T1 - Clinical predictors of and mortality in acute respiratory distress syndrome

T2 - Potential role of red cell transfusion

AU - Gong, Michelle Ng

AU - Thompson, B. Taylor

AU - Williams, Paige

AU - Pothier, Lucille

AU - Boyce, Paul D.

AU - Christiani, David C.

PY - 2005/6

Y1 - 2005/6

N2 - Objective: Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS risk and mortality including the role of red cell transfusion. Design: Observational prospective cohort. Setting: Intensive care unit of Massachusetts General Hospital. Patients: We studied 688 patients with sepsis, trauma, aspiration, and hypertransfusion. Interventions: None. Measurements and Main Results: Two hundred twenty-one (32%) subjects developed ARDS with a 60-day mortality rate of 46%. Significant predictors for ARDS on multivariate analyses included trauma (adjusted odds ratio [ORadj] 0.22,95% confidence interval [Cl] 0.09-0.53), diabetes (ORadj 0.58, 95% Cl 0.36-0.92), direct pulmonary injury (ORadj 3.78, 95% Cl 2.45-5.81), hematologic failure (ORadj 1.84, 95% Cl 1.05-3.21), transfer from another hospital (ORadj 2.08, 95% Cl 1.33-3.25), respiratory rate >33 breaths/min (ORadj 2.39, 95% Cl 1.51-3.78), hematocrit >37.5% (ORadj 1.77, 95% Cl 1.14-2.77), arterial pH <7.33 (ORadj 2.00, 95% Cl 1.31-3.05), and albumin ≤2.3 g/dL (ORadj 1.80, 95% Cl 1.18-2.73). Packed red blood cell transfusion was associated with ARDS (ORadj 1.52, 95% Cl 1.00-2.31, p = .05). Significant predictors for mortality in ARDS included age (ORadj 1.96, 95% Cl 1.50-2.53), Acute Physiology and Chronic Health Evaluation III score (ORadj 1.78, 95% Cl 1.16-2.73), trauma (ORadj 0.075, 95% Cl 0.006-0.96), corticosteroids before ARDS (ORadj 4.65, 95% Cl 1.47-14.7), and arterial pH <7.22 (ORadj 2.32, 95% Cl 1.02-5.25). Packed red blood cell transfusions were associated with increased mortality in ARDS (ORadj 1.10 per unit transfused; 95% Cl 1.04-1.17) with a significant dose-dependent response (p = .02). Conclusions: Important predictors for the development of and mortality in ARDS were identified. Packed red blood cell transfusion was associated with an increased development of and increased mortality in ARDS.

AB - Objective: Clinical predictors for acute respiratory distress syndrome (ARDS) have been studied in few prospective studies. Although transfusions are common in the intensive care unit, the role of submassive transfusion in non-trauma-related ARDS has not been studied. We describe here the clinical predictors of ARDS risk and mortality including the role of red cell transfusion. Design: Observational prospective cohort. Setting: Intensive care unit of Massachusetts General Hospital. Patients: We studied 688 patients with sepsis, trauma, aspiration, and hypertransfusion. Interventions: None. Measurements and Main Results: Two hundred twenty-one (32%) subjects developed ARDS with a 60-day mortality rate of 46%. Significant predictors for ARDS on multivariate analyses included trauma (adjusted odds ratio [ORadj] 0.22,95% confidence interval [Cl] 0.09-0.53), diabetes (ORadj 0.58, 95% Cl 0.36-0.92), direct pulmonary injury (ORadj 3.78, 95% Cl 2.45-5.81), hematologic failure (ORadj 1.84, 95% Cl 1.05-3.21), transfer from another hospital (ORadj 2.08, 95% Cl 1.33-3.25), respiratory rate >33 breaths/min (ORadj 2.39, 95% Cl 1.51-3.78), hematocrit >37.5% (ORadj 1.77, 95% Cl 1.14-2.77), arterial pH <7.33 (ORadj 2.00, 95% Cl 1.31-3.05), and albumin ≤2.3 g/dL (ORadj 1.80, 95% Cl 1.18-2.73). Packed red blood cell transfusion was associated with ARDS (ORadj 1.52, 95% Cl 1.00-2.31, p = .05). Significant predictors for mortality in ARDS included age (ORadj 1.96, 95% Cl 1.50-2.53), Acute Physiology and Chronic Health Evaluation III score (ORadj 1.78, 95% Cl 1.16-2.73), trauma (ORadj 0.075, 95% Cl 0.006-0.96), corticosteroids before ARDS (ORadj 4.65, 95% Cl 1.47-14.7), and arterial pH <7.22 (ORadj 2.32, 95% Cl 1.02-5.25). Packed red blood cell transfusions were associated with increased mortality in ARDS (ORadj 1.10 per unit transfused; 95% Cl 1.04-1.17) with a significant dose-dependent response (p = .02). Conclusions: Important predictors for the development of and mortality in ARDS were identified. Packed red blood cell transfusion was associated with an increased development of and increased mortality in ARDS.

KW - Acute lung injury

KW - Acute respiratory distress syndrome

KW - Mortality

KW - Respiratory failure

KW - Transfusion

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