Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

Graciela J. Soto, Daryl J. Kor, Pauline K. Park, Peter C. Hou, David A. Kaufman, Mimi Kim, Hemang Yadav, Nicholas Teman, Michael C. Hsu, Tatyana Shvilkina, Yekaterina Grewal, Manuel de Aguirre, Sampath Gunda, Ognjen Gajic, Michelle Ng Gong

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE:: The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact. DESIGN:: Retrospective study. SETTING:: Five academic medical centers. PATIENTS:: Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2–3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21–1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18–1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26–7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68–3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05–6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value. CONCLUSIONS:: In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.

Original languageEnglish (US)
JournalCritical Care Medicine
DOIs
StateAccepted/In press - Aug 10 2016

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Adult Respiratory Distress Syndrome
Lung Injury
Critical Care
Odds Ratio
Hospital Emergency Service
Hospital Mortality
ROC Curve
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)
  • Critical Care and Intensive Care Medicine

Cite this

Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome. / Soto, Graciela J.; Kor, Daryl J.; Park, Pauline K.; Hou, Peter C.; Kaufman, David A.; Kim, Mimi; Yadav, Hemang; Teman, Nicholas; Hsu, Michael C.; Shvilkina, Tatyana; Grewal, Yekaterina; de Aguirre, Manuel; Gunda, Sampath; Gajic, Ognjen; Gong, Michelle Ng.

In: Critical Care Medicine, 10.08.2016.

Research output: Contribution to journalArticle

Soto, GJ, Kor, DJ, Park, PK, Hou, PC, Kaufman, DA, Kim, M, Yadav, H, Teman, N, Hsu, MC, Shvilkina, T, Grewal, Y, de Aguirre, M, Gunda, S, Gajic, O & Gong, MN 2016, 'Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome', Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000002001
Soto, Graciela J. ; Kor, Daryl J. ; Park, Pauline K. ; Hou, Peter C. ; Kaufman, David A. ; Kim, Mimi ; Yadav, Hemang ; Teman, Nicholas ; Hsu, Michael C. ; Shvilkina, Tatyana ; Grewal, Yekaterina ; de Aguirre, Manuel ; Gunda, Sampath ; Gajic, Ognjen ; Gong, Michelle Ng. / Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome. In: Critical Care Medicine. 2016.
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title = "Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome",
abstract = "OBJECTIVE:: The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact. DESIGN:: Retrospective study. SETTING:: Five academic medical centers. PATIENTS:: Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7{\%}) a median of 2 days (interquartile range, 2–3) after critical care contact. Hospital mortality was 22{\%} and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48{\%} vs 18{\%}; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95{\%} CI, 1.21–1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95{\%} CI, 1.18–1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95{\%} CI, 2.26–7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95{\%} CI, 1.68–3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95{\%} CI, 2.05–6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90{\%} sensitivity (misses only 10{\%} of acute respiratory distress syndrome cases), 31{\%} specificity, 17{\%} positive predictive value, and 95{\%} negative predictive value. CONCLUSIONS:: In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.",
author = "Soto, {Graciela J.} and Kor, {Daryl J.} and Park, {Pauline K.} and Hou, {Peter C.} and Kaufman, {David A.} and Mimi Kim and Hemang Yadav and Nicholas Teman and Hsu, {Michael C.} and Tatyana Shvilkina and Yekaterina Grewal and {de Aguirre}, Manuel and Sampath Gunda and Ognjen Gajic and Gong, {Michelle Ng}",
year = "2016",
month = "8",
day = "10",
doi = "10.1097/CCM.0000000000002001",
language = "English (US)",
journal = "Critical Care Medicine",
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T1 - Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome

AU - Soto, Graciela J.

AU - Kor, Daryl J.

AU - Park, Pauline K.

AU - Hou, Peter C.

AU - Kaufman, David A.

AU - Kim, Mimi

AU - Yadav, Hemang

AU - Teman, Nicholas

AU - Hsu, Michael C.

AU - Shvilkina, Tatyana

AU - Grewal, Yekaterina

AU - de Aguirre, Manuel

AU - Gunda, Sampath

AU - Gajic, Ognjen

AU - Gong, Michelle Ng

PY - 2016/8/10

Y1 - 2016/8/10

N2 - OBJECTIVE:: The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact. DESIGN:: Retrospective study. SETTING:: Five academic medical centers. PATIENTS:: Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2–3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21–1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18–1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26–7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68–3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05–6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value. CONCLUSIONS:: In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.

AB - OBJECTIVE:: The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact. DESIGN:: Retrospective study. SETTING:: Five academic medical centers. PATIENTS:: Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2–3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21–1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18–1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26–7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68–3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05–6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value. CONCLUSIONS:: In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.

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