Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS.
Biomarkers
Female
Humans
Image Processing, Computer-Assisted
Lung
/ diagnostic imaging
Male
Middle Aged
Organ Dysfunction Scores
Outcome and Process Assessment, Health Care
Prognosis
Proportional Hazards Models
Pulmonary Edema
/ diagnosis
Radiography
/ methods
Respiratory Distress Syndrome
/ mortality
Severity of Illness Index
Survival Analysis
ARDS
radiographic score
survival
treatable trait
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
30
03
2020
revised:
10
06
2020
accepted:
26
06
2020
pubmed:
14
7
2020
medline:
27
5
2021
entrez:
14
7
2020
Statut:
ppublish
Résumé
The Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time. Are early changes in RALE score over time associated with survival in patients with ARDS? Data from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model. RALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry. The change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.
Sections du résumé
BACKGROUND
The Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time.
RESEARCH QUESTION
Are early changes in RALE score over time associated with survival in patients with ARDS?
STUDY DESIGN AND METHODS
Data from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model.
RESULTS
RALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry.
INTERPRETATION
The change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.
Identifiants
pubmed: 32659235
pii: S0012-3692(20)31874-2
doi: 10.1016/j.chest.2020.06.070
pmc: PMC7768934
pii:
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2394-2403Subventions
Organisme : NHLBI NIH HHS
ID : K24 HL103836
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126176
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126671
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL135849
Pays : United States
Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.
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