title: Quality-adjusted survival in the first year after the acute respiratory distress syndrome.
abstract: There is little information on long-term outcome after acute respiratory distress syndrome (ARDS). We measured quality-adjusted survival in the first year after ARDS in a prospective cohort (n = 200). All patients met traditional criteria for ARDS. Patients with sepsis and acute nonpulmonary organ dysfunction at presentation were excluded. The cohort was healthy before onset of ARDS as evidenced by high functional status (mean Karnofsky Performance Status index: 82.2/100 where >/= 80 = able to perform normal activities independently) and minimal comorbid illness (mean Charlson-Deyo comorbidity score: 0.32/17 where 0 = absence of chronic illness). We determined quality-adjusted life-years (QALYs) using the Quality of Well-being (QWB) scale (0 to 1 scale where 1 = optimal well-being), measured at 6 and 12 mo. Survival was 69.5 +/- 5.0% at 1 month, fell to 55.7 +/- 3.7% at 6 mo, and did not change at 12 mo, yielding a survival of 59 life-years in the first year per 100 patients with ARDS. QWB was low at 6 and 12 mo (0.59 +/- 0.015 and 0.60 +/- 0.015), yielding a quality-adjusted survival of 36 QALYs per 100 patients (sensitivity range: 21 to 46 QALYs). We conclude that ARDS developing in previously healthy patients is associated with poor quality-adjusted survival. These data are important for cost-effectiveness analyses and long-term care.
authors.affiliation: Critical Care Medicine Division, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA. angusdc@anes.upmc.edu
authors.forename: D C
authors.initials: DC
authors.lastname: Angus
authors.forename: A A
authors.initials: AA
authors.lastname: Musthafa
authors.forename: G
authors.initials: G
authors.lastname: Clermont
authors.forename: M F
authors.initials: MF
authors.lastname: Griffin
authors.forename: W T
authors.initials: WT
authors.lastname: Linde-Zwirble
authors.forename: T T
authors.initials: TT
authors.lastname: Dremsizov
authors.forename: M R
authors.initials: MR
authors.lastname: Pinsky
mesh_terms: D018806:APACHE; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000188:drug therapy / Q000401:mortality* / Q000523:psychology*; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology*; D014481:United States / Q000453:epidemiology
chemical_list: D009569:Nitric Oxide