The association between prehospital vulnerability, ards development, and mortality among at-risk adults results from the lips-a clinical trial

Aluko A. Hope, Jen Ting Chen, David A. Kaufman, Daniel S. Talmor, Daryl J. Kor, Ognjen Gajic, Michelle N. Gong

Research output: Contribution to journalArticle


Rationale: No previous studies have examined the role of prehospital vulnerability in acute respiratory distress syndrome (ARDS) development and mortality in an acutely ill adult population. Objectives: To describe the association between prehospital vulnerability and 1) the development of ARDS, 2) 28-day mortality, and 3) 1-year mortality. Methods: This was a longitudinal prospective cohort study nested within the multicenter LIPS-A (Lung Injury Prevention Study-Aspirin) trial. We analyzed 301 participants who completed Vulnerable Elders Survey (VES) at baseline. Multivariable logistic regression and Cox regression analyses were used to describe the association between vulnerability and short-term outcomes (ARDS and 28-day mortality) and long-term outcomes (1-year mortality), respectively. Results: The VES score ranged from 0 to 10 (median [interquartile range], 2.0 [0-6]); 143 (47.5%) fit criteria for prehospital vulnerability (VES>3). Vulnerability was not significantly associated with ARDS development (10 [7.0%] vulnerable patients developed ARDS as per LIPS-A study criteria vs. 20 [12.7%] without vulnerability; P=0.10; adjusted odds ratio [95% confidence interval (CI)], 0.54 [0.24-1.24]; P = 0.15). Nor was vulnerability associated with 28-day mortality (15 [10.5%] vulnerable patients were dead by Day 28 vs. 11 [7.0%] nonvulnerable patients; P = 0.28; adjusted odds ratio [95% CI], 0.95 [0.39-2.26]; P = 0.90). Vulnerability was significantly associated with 1-year mortality in hospital survivors (35 [26.9%] vs. 13 [9.3%]; adjusted hazard ratio [95% CI], 2.20 [1.10-4.37]; P=0.02). Conclusions: In a population of adults recruited for their high risk of ARDS, prehospital vulnerability, measured by VES, was highly prevalent and strongly associated with 1-year mortality.

Original languageEnglish (US)
Pages (from-to)1399-1404
Number of pages6
JournalAnnals of the American Thoracic Society
Issue number11
StatePublished - Jan 1 2019



  • Acute respiratory distress syndrome
  • Frailty
  • Outcomes
  • Survivors

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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