One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome

Abstract

Purpose Advances in supportive care and ventilator management for the acute respiratory distress syndrome (ARDS) have resulted in declines in short-term mortality, but risks of death after survival to hospital discharge have not been well described. Our objective was to quantify the difference between short-term and long-term mortality in ARDS and to identify risk factors for death and causes of death at one year among hospital survivors. Methods This multi-intensive care unit, prospective cohort included patients with ARDS enrolled between January 2006 and February 2010. We determined the clinical characteristics associated with in-hospital and 1-year mortality among hospital survivors and utilized death certificate data to identify causes of death. Results Of 646 patients hospitalized with ARDS, mortality at one year was substantially higher (41%, 95% CI 37–45%) than in-hospital mortality (24%, 95% CI 21–27%), P<0.0001. Among 493 patients who survived to hospital discharge, the 110 (22%) who died in the subsequent year were older (P < 0.001) and more likely to have been discharged to a nursing home, other hospital or hospice compared to patients alive at one year (P < 0.001). Important predictors of death among hospital survivors were comorbidities present at the time of ARDS, and not living at home prior to admission. ARDS-related measures of severity of illness did not emerge as independent predictors of mortality in hospital survivors. Conclusions Despite improvements in short-term ARDS outcomes, one-year mortality is high, in large part due to the large burden of comorbidities, which are prevalent in patients with ARDS.

What's Next After ARDS: Long-Term Outcomes

“…Hospital mortality was significantly lower (24%) than 1-y mortality after hospital discharge (41%) regardless of the etiology of ARDS. 28 Both the severity and the presence of ARDS did not increase the risk of mortality during a median follow-up time of 2 y in sepsis or trauma subjects with ARDS compared with equally ill subjects without ARDS (sepsis-ARDS subjects 39 Survival 3 y Survival of patients treated with rescue therapies was 65% at 3 y after H discharge, comparable with survival of conventionally treated subjects Wilcox (2013) 40 Pulmonary function [13%]). 15 Age and comorbidities, in addition to the sepsis, strongly influenced the late mortality.…”

Titulação de PEEP por manobra rápida versus lenta utilizando tomografia de impedância elétrica, e estabilidade da função pulmonar com estratégia ventilatória protetora em modelo suíno de síndrome do desconforto respiratório agudo

“…Villar et al (5) , em estudo multicêntrico observacional, relataram uma incidência de SDRA de 7.2/100.000 habitantes por ano, sendo pneumonia e sepse as causas mais comumente associadas à esta síndrome. A letalidade da SDRA também é alta, foi relatado uma mortalidade de 41% nesta população com um seguimento de 493 pacientes com SDRA por um ano (6) .…”

Evaluation of acute physiology and chronic health evaluation (APACHE) II in predicting ICU mortality among critically ill

“…Abdulbaset Saleh et.al form Egypt also reported that mortality rate among critically ill patients diagnosed with acute respiratory distress syndrome was 27.3%. 23 Costa et.al found a mortality rate of 28.5% among patients in intensive care units. [24][25][26] The MICU were the study was done had an actual mortality of eleven (9%) patients from January 2017 to March 2017 which was comparatively lesser than reported from a study conducted in Kerala which had a mortality rate of 16.7%(15 patients ) died in intensive care unit during one month period.…”