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Ann Intensive Care. 2017 Dec;7(1):69. doi: 10.1186/s13613-017-0281-6. Epub 2017 Jun 19.

Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicenter study.

Author information

1
Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil Cedex, 94010, France. nicolas.de-prost@aphp.fr.
2
Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil Cedex, 94010, France. nicolas.de-prost@aphp.fr.
3
Service de Réanimation Médicale, Hôpital Henri Mondor, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. nicolas.de-prost@aphp.fr.
4
Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Pôle Thorax Voies aériennes, Unité de Réanimation médico-chirurgicale, Hôpital Tenon, AP-HP, Paris, France.
5
ECSTRA Team, Inserm, UMR 1153, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
6
Inserm, UMR 915, Université Paris Est Créteil, Créteil Cedex, France.
7
Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
8
Service de Réanimation Médicale, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil Cedex, 94010, France.
9
Groupe de Recherche Clinique CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, Créteil Cedex, 94010, France.
10
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
11
School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
12
Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
13
Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada.
14
Departments of Anesthesia, Physiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
15
Service de Réanimation Médicale, Centre Hospitalier Universitaire d'Angers, Angers, France.

Abstract

BACKGROUND:

Patients meeting the Berlin definition for the acute respiratory distress syndrome (ARDS) might lack exposure to one or more "common" risk factors and exhibit different clinical phenotype and outcomes. We aimed to compare the clinical presentation and outcome of ARDS patients with or without risk factors, the impact on hospital mortality, and to assess the diagnostic work-up performed. The current study is an ancillary analysis of an international, multicenter, prospective cohort study (the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure, LUNG SAFE). Patients meeting ARDS criteria within 2 days of acute hypoxemic respiratory failure onset were included in the study and categorized as having risk factors or not. Outcomes were compared using propensity score matching.

RESULTS:

Among 2813 patients, 234 (8.3% [7.3-9.3]) had no ARDS risk factor identified. These were older, had more frequent chronic diseases and presented with less severe SOFA and non-pulmonary SOFA scores (p < 0.001). Compared to other ARDS, CT scan (32.1 vs 23.9%, p < 0.001) and open lung biopsy (2.6 vs 0.2%, p < 0.001) were slightly more frequent but left heart filling pressures assessment was not (69.4 vs 68.4%, p > 0.99). Among ARDS with no risk factor, 45 patients (19.2%) had a specific diagnosis made. As compared to others, patients having ARDS with no risk factor had a lower ICU but not hospital mortality (34.6 vs 40.0%; p = 0.12). A matched cohort analysis confirmed the lack of significant difference in mortality.

CONCLUSION:

Eight percent of ARDS patients have no identified risk factor, 80% of whom have no etiological diagnosis made. The outcome of ARDS with no risk factor was comparable to other ARDS but few had a comprehensive diagnostic work-up, potentially leading to missed curable diseases. Trial registration clinicaltrials.gov Identifier: NCT02010073.

KEYWORDS:

Berlin definition; Diagnostic techniques and procedures; Outcomes; Respiratory distress syndrome, adult

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