Association between age and acute respiratory distress syndrome development and mortality following trauma

Abstract

Background: Improved understanding of the relationship between patient age and acute respiratory distress syndrome (ARDS) development and mortality following traumatic injury may help facilitate generation of new hypotheses about ARDS pathophysiology and the role of novel treatments to improve outcomes across the age spectrum. Methods: We conducted a retrospective cohort study of trauma patients included in the National Trauma Data Bank who were admitted to an intensive care unit from 2007-2016. We determined ARDS incidence and mortality across eight age groups for the entire 10-year study period and by year. We used generalized linear Poisson regression models adjusted for underlying mortality risk (injury mechanism, Injury Severity Score, admission Glasgow Coma Scale score, admission heart rate, and admission hypotension). Results: ARDS occurred in 3.1% of 1,297,190 trauma encounters. ARDS incidence was lowest among pediatric patients and highest among adults ages 35-64. ARDS mortality was highest among patients ≥80 years (43.9%) followed by 65-79 years (30.6%) and ≤4 years (25.3%). The relative risk of mortality associated with ARDS was highest among the pediatric age groups, with an adjusted relative risk (aRR) of 2.06 (95% CI 1.72-2.70) among patients ≤4 years old compared to an aRR of 1.51 (95% CI 1.42-1.62) for the entire cohort. ARDS mortality increased over the

Mortality rates due to respiratory tract diseases in Tehran, Iran during 2008–2018: a spatiotemporal, cross-sectional study

“…This is not surprising as men are supposedly more exposed to environmental factors than women [23]. The age-adjusted MRRSDs were higher in the > 65 years age group, which has also been reported in various geographical regions [14][15][16].…”

“…Meanwhile, Adegboye et al found that interventions to minimise mortality from the Middle East respiratory syndrome (MERS) coronavirus had a particular focus on individuals with co-morbidities, workers outside the health-care field and patients without clinical experience [12], and Chowell et al noted a high geographic heterogeneity in the impact of the 1918-1919 influenza pandemic mortality in Spain [13]. Other studies have confirmed a significantly robust relationship between MRRSDs and ageing [14][15][16]. Lai et al [17] incorporated stochastic processing of environmental and social variables that interact in space and time to affect the patterns of disease transmission in a community.…”

The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview

“…Several investigators have reported age as an independent predictor of mortality in ARDS (40,41). It should be emphasized that substantial heterogeneity exists within the syndrome and non-linear associations between age and mortality have been reported within specific ARDS phenotypes [i.e., trauma; (42,43)]. When considering the trauma-ARDS cohort, the highest burden of mortality has been shown to exist at the extremes of age (42,43).…”

“…It should be emphasized that substantial heterogeneity exists within the syndrome and non-linear associations between age and mortality have been reported within specific ARDS phenotypes [i.e., trauma; (42,43)]. When considering the trauma-ARDS cohort, the highest burden of mortality has been shown to exist at the extremes of age (42,43). A large retrospective review of a national trauma database (n = 1,297,190) reported the ARDSrelated mortality was highest in those ≥80 and ≤4 years (42).…”

“…When considering the trauma-ARDS cohort, the highest burden of mortality has been shown to exist at the extremes of age (42,43). A large retrospective review of a national trauma database (n = 1,297,190) reported the ARDSrelated mortality was highest in those ≥80 and ≤4 years (42). Other investigators have reported no significant difference in mortality using a dichotomous age cut-off of 65 years, potentially supporting the notion that the relationship between age and ARDS may be more complex (44).…”