Background
Methods
Protocol
Biochemistry
Statistical analysis
Results
Patients
Berlin category | 0 | 1 | 2 | 3 | P-value |
---|---|---|---|---|---|
N = 53 | N = 9 | N = 32 | N = 7 | ||
Age, years | 61 (30) | 71 (22) | 63 (24) | 69 (29) | 0.21 |
Sex, male | 39 (74) | 5 (56) | 20 (63) | 5 (71) | 0.60 |
SAPS II admission | 46 (20) | 59 (24) | 49 (16) | 44 (57) | 0.39 |
SOFA D0 | 7 (4) | 8 (5) | 9 (5) | 10 (5) | 0.06 |
ICU days until inclusion | 6 (12) | 7 (19) | 8 (12) | 9 (32) | 0.98 |
CVP D0, mmHg | 9 (5) | 5 (2) | 6 (6) | 7 (3) | 0.26 |
CVP D1, mmHg | 8 (5) | 6 (5) | 7 (4) | 6 (0) | 0.83 |
CVP D2, mmHg | 7 (4) | 9 (2) | 6 (4) | 5 (0) | 0.25 |
CVP D7, mmHg | 7 (4) | 9 (4) | 7 (5) | 9 (1) | 0.49 |
Vasopressor use D0-7 | 28 (53) | 6 (67) | 23 (72) | 5 (71) | 0.20 |
Renal replacement therapy D0-7 | 3 (6) | 1 (11) | 4 (13) | 0 | 0.57 |
Albumin 20% administration (100 mL) D0-7 | 3 (6) | 2 (22) | 8 (25) | 0 | 0.03 |
Corticosteroids use D -7-0 | 23 (43) | 5 (56) | 14 (44) | 3 (43) | 0.92 |
Corticosteroid use D 0-7 | 23 (43) | 7 (78) | 16 (50) | 4 (57) | 0.28 |
28-day mortality | 9 (17) | 4 (44) | 10 (31) | 3 (43) | 0.15 |
LIS category
|
LIS <1
|
LIS 1.0-2.5
|
LIS >2.5
| ||
N =14
|
N = 69
|
N =18
|
P-value
| ||
Age, years | 62 (28) | 63 (24) | 59 (28) | 0.92 | |
Sex, man | 10 (71) | 47 (68) | 12 (67) | 0.96 | |
SAPS II at admission | 49 (20) | 47 (20) | 45 (23) | 0.35 | |
SOFA D0 | 5 (2) | 8 (5) | 10 (3) | 0.004 | |
ICU days until inclusion | 6 (14) | 7 (9) | 6 (12) | 0.85 | |
CVP D0, mmHg | 8 (6) | 7 (5) | 8 (5) | 0.79 | |
CVP D1, mmHg | 7 (4) | 7 (6) | 7 (4) | 0.50 | |
CVP D2, mmHg | 3 (0) | 7 (3) | 7 (6) | 0.32 | |
CVP D7, mmHg | 6 (7) | 7 (5) | 8 (3) | 0.61 | |
Vasopressor use D0-7 | 5 (39) | 4 (63) | 14 (82) | 0.05 | |
Renal replacement therapy D0-7 | 0 | 7 (10) | 1 (6) | 0.40 | |
Albumin 20% administration (100 mL) D 0-7 | 0 | 12 (17) | 1 (6) | 0.12 | |
Corticosteroids use D -7-0 | 6 (43) | 31 (45) | 8 (44) | 0.99 | |
Corticosteroid use D 0-7 | 4 (29) | 35 (51) | 11 (61) | 0.18 | |
28-day mortality | 2 (14) | 18 (26) | 6 (33) | 0.47 |
Berlin category | 0 | 1 | 2 | 3 | P-value |
---|---|---|---|---|---|
N = 53 | N = 9 | N = 32 | N = 7 | ||
Ventilator course D0-7
| |||||
Mechanical ventilation D0 | 47 (89) | 9 (100) | 32 (100) | 7 (100) | 0.12 |
duration, days | 22 (30) | 23 (27) | 22 (25) | 16 (26) | 0.85 |
PaO2/FIO2 ratio D0 | 180 (76) | 226 (60) | 155 (49) | 89 (32) | <0.001 |
PaO2/FIO2 ratio D1 | 191 (66) | 208 (64) | 156 (34) | 91 (0) | <0.001 |
PaO2/FIO2 ratio D2 | 194 (105) | 252 (41) | 168 (35) | 68 (0) | <0.001 |
PaO2/FIO2 ratio D7 | 189 (110) | 239 (23) | 161 (48) | 73 (21) | <0.001 |
PEEP D0, cmH20 | 8 (7) | 8 (4) | 10 (4) | 10 (2) | 0.10 |
PEEP D1, cmH20 | 8 (7) | 8 (6) | 10 (4) | 13 (0) | 0.13 |
PEEP D2, cmH20 | 8 (7) | 10 (6) | 10 (4) | 8 (0) | 0.40 |
PEEP D7, cmH20 | 6 (6) | 11 (7) | 9 (4) | 13 (8) | 0.001 |
Compliance D0, mL/cmH20 | 32 (23) | 39 (13) | 38 (23) | 36 (27) | 0.88 |
Compliance D1, mL/cmH20 | 39 (18) | 35 (24) | 35 (18) | 21 (0) | 0.24 |
Compliance D2, mL/cmH20 | 35 (20) | 40 (30) | 35 (20) | 33 (0) | 0.78 |
Compliance D7, mL/cmH20 | 47 (34) | 31 (12) | 37 (24) | 19 (9) | 0.11 |
Tidal volume D0, mL | 500 (217) | 500 (116) | 520 (206) | 530 (256) | 0.92 |
Tidal volume D1, mL | 520 (120) | 500 (140) | 500 (210) | 530 (150) | 0.68 |
Tidal volume D2, mL | 520 (123) | 500 (147) | 505 (250) | 550 (300) | 0.78 |
Tidal volume D7, mL | 530 (192) | 463 (216) | 500 (150) | 450 (250) | 0.17 |
Chest radiograph D0, quadrants | 1 (1) | 2 (0) | 2 (1) | 2 (1) | <0.001 |
Chest radiograph D1, quadrants | 1 (1) | 2 (0) | 2 (1) | 2 | <0.001 |
Chest radiograph D2, quadrants | 1 (1) | 2 (1) | 2 (1) | 3 | <0.001 |
Chest radiograph D7, quadrants | 0 (1) | 2 (0) | 2 (2) | 3 (1) | <0.001 |
LIS category
|
LIS <1
|
LIS 1.0-2.5
|
LIS >2.5
| ||
N =14
|
N = 69
|
N =18
|
P-value
| ||
Ventilator course D0-7
| |||||
Mechanical ventilation D0 | 10 (71) | 67 (97) | 18 (100) | 0.001 | |
duration, days | 11 (20) | 22 (27) | 28 (21) | 0.07 | |
PaO2/FIO2 ratio D0 | 214 (130) | 174 (68) | 112 (70) | <0.001 | |
PaO2/FIO2 ratio D1 | 238 (157) | 184 (60) | 149 (40) | <0.001 | |
PaO2/FIO2 ratio D2 | 284 (111) | 181 (72) | 156 (48) | <0.001 | |
PaO2/FIO2 ratio D7 | 269 (162) | 177 (79) | 102 (78) | <0.001 | |
PEEP D0, cmH20 | 5 (2) | 9 (6) | 14 (3) | <0.001 | |
PEEP D1, cmH20 | 5 (1) | 9 (4) | 13 (4) | <0.001 | |
PEEP D2, cmH20 | 5 (1) | 9 (5) | 12 (6) | <0.001 | |
PEEP D7, cmH20 | 4 (3) | 8 (6) | 14 (5) | <0.001 | |
Compliance D0, mL/cmH20 | 44 (57) | 39 (20) | 27 (18) | <0.001 | |
Compliance D1, mL/cmH20 | 51 (25) | 37 (18) | 28 (21) | <0.001 | |
Compliance D2, mL/cmH20 | 61 (105) | 35 (19) | 31 (21) | 0.01 | |
Compliance D7, mL/cmH20 | 65 (75) | 37 (24) | 20 (11) | 0.007 | |
Tidal volume D0, mL | 409 (268) | 500 (176) | 550 (154) | 0.39 | |
Tidal volume D1, mL | 523 (177) | 500 (166) | 523 (95) | 0.92 | |
Tidal volume D2, mL | 490 (138) | 525 (133) | 535 (194) | 0.43 | |
Tidal volume D7, mL | 450 (150) | 500 (213) | 500 (138) | 0.71 | |
Chest radiograph D0, no quadrants | 0 (1) | 2 (1) | 2 (3) | <0.001 | |
Chest radiograph D1, no quadrants | 1 (1) | 1 (1) | 2 (2) | <0.001 | |
Chest radiograph D2, no quadrants | 0 (1) | 2 (1) | 2 (3) | <0.001 | |
Chest radiograph D7, no quadrants | 1 (0) | 2 (1) | 2 (1) | 0.005 |
Berlin category | 0 | 1 | 2 | 3 | P-value |
---|---|---|---|---|---|
N = 53 | N = 9 | N = 32 | N = 7 | ||
ARDS risk factors on ICU admission
| |||||
Sepsis | 14 (26) | 4 (44) | 12 (38) | 1 (14) | 0.42 |
Shock | 8 (15) | 3 (33) | 9 (28) | 0 | 0.18 |
Trauma | 11 (21) | 0 | 2 (6) | 0 | 0.09 |
General surgery | 30 (57) | 3 (33) | 16 (50) | 5 (71) | 0.43 |
Vascular surgery | 4 (8) | 1 (1) | 3 (9) | 2 (29) | 0.38 |
Cardiac surgery | 3 (6) | 0 | 2 (6) | 1 (14) | 0.69 |
Intracranial bleeding | 10 (19) | 2 (22) | 1 (3) | 1 (14) | 0.19 |
CPR | 6 (11) | 1 (11) | 2 (6) | 1 (14) | 0.86 |
Other | 7 (13) | 0 | 2 (6) | 0 | 0.38 |
ARDS risk factors on D0
| |||||
Sepsis | 29 (56) | 4 (44) | 13 (41) | 4 (57) | 0.66 |
Shock | 14 (26) | 5 (56) | 14 (44) | 4 (57) | 0.13 |
Pneumonia | 3 (6) | 0 | 4 (13) | 2 (29) | 0.14 |
Aspiration pneumonia | 3 (6) | 0 | 0 | 0 | 0.43 |
Peritonitis | 3 (6) | 1 (11) | 1 (3) | 0 | 0.71 |
Infected pancreatitis | 2 (4) | 0 | 1 (3) | 0 | 0.89 |
Miscellaneous infection | 20 (38) | 2 (22) | 10 (31) | 3 (43) | 0.75 |
Surgery within 48 hrs prior to inclusion | 8 (15) | 1 (11) | 4 (13) | 0 | 0.73 |
LIS category
|
LIS ≤1.0
|
LIS 1.0-2.5
|
LIS >2.5
|
P-value
| |
N =14
|
N = 69
|
N =18
| |||
ARDS risk factors on ICU admission
| |||||
Sepsis | 3 (21) | 22 (32) | 6 (33) | 0.72 | |
Shock | 2 (14) | 17 (25) | 1 (6) | 0.17 | |
Trauma | 1 (7) | 10 (15) | 2 (11) | 0.73 | |
General surgery | 8 (57) | 37 (54) | 9 (50) | 0.92 | |
Vascular surgery | 0 | 8 (11) | 2 (11) | 0.41 | |
Cardiac surgery | 0 | 4 (6) | 2 (11) | 0.42 | |
Intracranial bleeding | 5 (36) | 7 (10) | 2 (11) | 0.04 | |
CPR | 1 (7) | 7 (10) | 2 (11) | 0.93 | |
Other | 3 (21) | 5 (7) | 1 (6) | 0.20 | |
ARDS risk factors on D0
| |||||
Sepsis | 9 (64) | 34 (49) | 7 (39) | 0.36 | |
Shock | 2 (14) | 27 (39) | 8 (44) | 0.16 | |
Pneumonia | 1 (7) | 6 (9) | 2 (11) | 0.92 | |
Aspiration pneumonia | 1 (7) | 1 (2) | 1 (6) | 0.41 | |
Peritonitis | 1 (7) | 3 (4) | 1 (6) | 0.90 | |
Infected pancreatitis | 2 (14) | 1 (1) | 0 | 0.03 | |
Miscellaneous infection | 7 (50) | 25 (36) | 3 (17) | 0.13 | |
Surgery within 48 hrs prior to inclusion | 1 (7) | 9 (13) | 3 (17) | 0.73 |
Association with ARDS severity
AUROC | 95% CI | P-value | Optimal cutoff | SN | SP | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
Maximum Berlin ≥1 (N = 59)
| ||||||||
Albumin | 0.65 | 0.53-0.76 | 0.01 | <20 g/L | 71 | 58 | 71 | 58 |
Maximum Berlin ≥2 (N = 50)
| ||||||||
Albumin | 0.63 | 0.52-0.74 | 0.02 | <20 g/L | 72 | 53 | 61 | 65 |
CRP | 0.62 | 0.51-0.74 | 0.03 | >138 mg/L | 54 | 76 | 69 | 62 |
Maximum LIS >1.0 (N = 95)
| ||||||||
CRP | 0.82 | 0.64-1.00 | 0.002 | >81 mg/L | 77 | 80 | 99 | 15 |
Maximum LIS >2.5 (N = 34)
| ||||||||
Albumin | 0.62 | 0.51-0.73 | 0.04 | <22 g/L | 91 | 31 | 41 | 87 |
Monitoring ARDS severity
AUROC | 95% CI | P-value | Optimal cutoff | SN | SP | PPV | NPV | ||
---|---|---|---|---|---|---|---|---|---|
Berlin ≥1
|
day 0
| ||||||||
Albumin | 0.62 | 0.52-0.72 | 0.03 | <20 g/L | 71 | 51 | 58 | 65 | |
day 1
| |||||||||
Albumin | 0.66 | 0.56-0.77 | 0.003 | <20 g/L | 84 | 44 | 55 | 77 | |
day 2
| |||||||||
Albumin | 0.67 | 0.56-0.78 | 0.002 | <17 g/L | 67 | 65 | 58 | 73 | |
day 7
| |||||||||
Albumin | 0.71 | 0.59-0.81 | <0.001 | <14 g/L | 38 | 92 | 81 | 63 | |
Berlin ≥2
|
day 1
| ||||||||
Albumin | 0.67 | 0.57-0.76 | 0.002 | <18 g/L | 73 | 54 | 44 | 80 | |
day 2
| |||||||||
Albumin | 0.68 | 0.58-0.77 | <0.001 | <17 g/L | 73 | 62 | 46 | 84 | |
day 7
| |||||||||
CRP | 0.65 | 0.53-0.76 | 0.045 | >105 mg/L | 67 | 64 | 47 | 80 | |
Berlin ≥3
|
day 7
| ||||||||
Albumin | 0.77 | 0.65-0.86 | 0.01 | <18 g/L | 100 | 49 | 10 | 100 | |
CRP | 0.91 | 0.82-0.97 | <0.001 | >162 mg/L | 100 | 73 | 19 | 100 | |
LIS >1
|
day 0
| ||||||||
CRP | 0.70 | 0.60-0.79 | 0.01 | >81 mg/L | 78 | 54 | 92 | 27 | |
day 1
| |||||||||
CRP | 0.65 | 0.55-0.75 | 0.04 | >182 mg/L | 42 | 92 | 97 | 20 | |
day 2
| |||||||||
Albumin | 0.82 | 0.73-0.89 | <0.001 | <21 g/L | 86 | 64 | 94 | 43 | |
day 7
| |||||||||
Albumin | 0.81 | 0.70-0.89 | <0.001 | <17 g/L | 56 | 92 | 97 | 31 | |
CRP | 0.79 | 0.68-0.87 | <0.001 | >60 mg/L | 68 | 79 | 93 | 36 | |
LIS >2.5
|
day 1
| ||||||||
Albumin | 0.69 | 0.56-0.78 | 0.02 | <11 g/L | 39 | 96 | 70 | 88 | |
day 7
| |||||||||
Albumin | 0.72 | 0.60-0.82 | 0.004 | <18 g/L | 83 | 53 | 26 | 94 | |
CRP | 0.83 | 0.73-0.91 | <0.001 | >158 mg/L | 75 | 80 | 41 | 94 |