Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study.
BACKGROUND
Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies.


OBJECTIVE
To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS).


METHODS
In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions.


RESULTS
Twenty-two hospitals enrolled 5,584 patients at risk. ALI developed a median of 2 (interquartile range 1-4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80 (95% confidence interval, 0.78-0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9-5.7).


CONCLUSIONS
ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies. Clinical trial registered with www.clinicaltrials.gov (NCT00889772).
Gajic
Ognjen
O
Mayo Clinic, Rochester, MN 55905, USA. gajic.ognjen@mayo.edu
Dabbagh
Ousama
O
Park
Pauline K
PK
Adesanya
Adebola
A
Chang
Steven Y
SY
Hou
Peter
P
Anderson
Harry
H
Hoth
J Jason
JJ
Mikkelsen
Mark E
ME
Gentile
Nina T
NT
Gong
Michelle N
MN
Talmor
Daniel
D
Bajwa
Ednan
E
Watkins
Timothy R
TR
Festic
Emir
E
Yilmaz
Murat
M
Iscimen
Remzi
R
Kaufman
David A
DA
Esper
Annette M
AM
Sadikot
Ruxana
R
Douglas
Ivor
I
Sevransky
Jonathan
J
Malinchoc
Michael
M
D055371:Acute Lung Injury / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors
Mayo Clin Proc. 2005 Jun;80(6):766-70
15945528
Thorax. 2009 Sep;64(9):784-90
19482841
Am J Respir Crit Care Med. 2006 Dec 1;174(11):1249-56
16973986
Am J Respir Crit Care Med. 2007 Nov 1;176(9):886-91
17626910
Dig Dis Sci. 1985 Oct;30(10):1005-18
3896700
Thorax. 2006 May;61(5):419-24
16449258
Ann Surg. 2000 Aug;232(2):242-53
10903604
Crit Care Med. 2002 Sep;30(9):2158-9
12352065
Crit Care Med. 2007 Jul;35(7):1660-6; quiz 1667
17507824
Crit Care Med. 2006 May;34(5 Suppl):S170-3
16617262
JAMA. 2000 Apr 19;283(15):1995-2002
10789668
Crit Care Med. 2000 Sep;28(9):3137-45
11008971
N Engl J Med. 2001 Nov 8;345(19):1368-77
11794169
Crit Care Med. 2004 Apr;32(4):946-54
15071383
Crit Care Med. 2001 Jul;29(7):1303-10
11445675
N Engl J Med. 1997 Jan 23;336(4):243-50
8995086
Dig Dis Sci. 1983 Feb;28(2):110-6
6825533
Thorax. 2009 Feb;64(2):121-7
18988659
N Engl J Med. 2001 Mar 1;344(9):665-71
11228282
Intensive Care Med. 2007 Apr;33(4):575-90
17285286
Thorax. 2010 Jan;65(1):44-50
19770169
Respir Physiol. 2001 Oct;128(1):13-6
11535257
Chest. 2003 Dec;124(6):2341-51
14665518
Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293-301
7842182
Chest. 2008 May;133(5):1113-9
17989156
Emerg Med Australas. 2007 Oct;19(5):418-26
17919214
Crit Care Med. 2000 Jul;28(7):2187-92
10921539
Ann Intern Med. 2007 Oct 16;147(8):573-7
17938396
Chest. 2009 Apr;135(4):936-943
19188549
Crit Care Med. 2008 May;36(5):1518-22
18434908
Crit Care Med. 2002 Jan;30(1):1-6
11902249
JAMA. 1996 Jan 3;275(1):50-4
8531287
Crit Care Med. 2005 Jun;33(6):1191-8
15942330
Crit Care Med. 1985 Oct;13(10):818-29
3928249
Am J Clin Oncol. 2008 Aug;31(4):340-4
18845992
Am J Respir Crit Care Med. 2003 Apr 1;167(7):1027-35
12663342
Intensive Care Med. 1996 Dec;22(12):1307-14
8986478
Clin Infect Dis. 2009 Feb 15;48(4):377-85
19140759
Chest. 2009 Jun;135(6):1572-1579
19141524
Crit Care. 2004 Oct;8(5):373-81
15469601
Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
7509706
Crit Care. 2007;11(5):R96
17784960
Crit Care Med. 1992 Jul;20(7):918-23
1617983
Chest. 2000 Jan;117(1):163-8
10631215
Ann Intern Med. 1983 May;98(5 Pt 1):593-7
6846973
Crit Care Med. 2004 Sep;32(9):1817-24
15343007
Crit Care Med. 2004 Aug;32(8):1695-702
15286546
Eur Respir J. 2011 Mar;37(3):604-9
20562130
Ann Intern Med. 2001 Nov 20;135(10):847-57
11712875
Chest. 1999 Jul;116(1 Suppl):74S-82S
10424602
Am J Surg. 1982 Jul;144(1):124-30
7091520
Thorax. 2004 May;59(5):421-7
15115872