Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

Abstract

Purpose To evaluate the association between acute respiratory distress syndrome (ARDS) onset time and prognosis. Methods Patients with moderate to severe ARDS (N = 876) were randomly assigned into derivation (N = 520) and validation (N = 356) datasets. Both 28-day and 60-day survival times after ARDS onset were analyzed. A data-driven cutoff point between early- and late-onset ARDS was determined on the basis of mortality risk effects of onset times. We estimated the hazard ratio (HR) and odds ratio (OR) of late-onset ARDS using a multivariate Cox proportional hazards model of survival time and a multivariate logistic regression model of mortality rate, respectively. Results Late-onset ARDS, defined as onset over 48 h after intensive care unit (ICU) admission (N = 273, 31%), was associated with shorter 28-day survival time: HR = 2.24, 95% CI 1.48–3.39, P = 1.24 × 10−4 (derivation); HR = 2.16, 95% CI 1.33–3.51, P = 1.95 × 10−3 (validation); and HR = 2.00, 95% CI 1.47–2.72, P = 1.10 × 10−5 (combined dataset). Late-onset ARDS was also associated with shorter 60-day survival time: HR = 1.70, 95% CI 1.16–2.48, P = 6.62 × 10−3 (derivation); HR = 1.78, 95% CI 1.15–2.75, P = 9.80 × 10−3 (validation); and HR = 1.59, 95% CI 1.20–2.10, P = 1.22 × 10−3 (combined dataset). Meanwhile, late-onset ARDS was associated with higher 28-day mortality rate (OR = 1.46, 95% CI 1.04–2.06, P = 0.0305) and 60-day mortality rate (OR = 1.44, 95% CI 1.03–2.02, P = 0.0313). Conclusions Late-onset moderate to severe ARDS patients had both shorter survival time and higher mortality rate in 28-day and 60-day observations.

Acute Respiratory Distress Syndrome Phenotypes

“…Zhang and colleagues studied patients with moderate to severe ARDS precipitated by a variety of ARDS risk factors, again dividing patients between early-and late-onset ARDS at 48 hours after admission. 78 In this study, late-onset ARDS was associated with a higher mortality than early-onset ARDS despite lower severity of illness scores at admission.…”

“…The Berlin Definition requires ARDS to develop within 1 week of the onset of the underlying precipitating illness 4 ; however, several researchers have identified significant heterogeneity based on the timing of onset of ARDS within that week. [75][76][77][78] Croce and colleagues first described early-and late-onset posttraumatic ARDS as distinct. 76 These authors defined early-onset ARDS as occurring within 48 hours after presentation and late-onset occurring beyond 48 hours after admission.…”

Whole blood microRNA markers are associated with acute respiratory distress syndrome

“…This nested case-control study was part of an ongoing Molecular Epidemiology Study of ARDS (MEARDS) at Harvard Medical School that was initiated in 2000. MEARDS has more than 4000 patients and includes both ARDS patients and at-risk controls who were critically ill patients admitted to the ICU of Massachusetts General Hospital (MGH; Boston, MA) or Beth Israel Deaconess Medical Center (BIDMC; Boston, MA) [ 13 , 14 ]. Commonly known ARDS risk factors and their definitions are listed in Additional file 1 : Table S1.…”

ARDS Subphenotypes: Understanding a Heterogeneous Syndrome

“…Both time of onset and duration of disease appear to hold prognostic value. Several studies have shown that ARDS onset >48 h after ICU admission is associated with higher mortality [15,16]. Not surprisingly, rapidly improving ARDS (ARDS that resolves within 1 day) has a better prognosis than persistent ARDS.…”