title: Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study.
abstract: 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).
authors.affiliation: Mayo Clinic, Rochester, MN 55905, USA. gajic.ognjen@mayo.edu
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Ousama
authors.initials: O
authors.lastname: Dabbagh
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.forename: Adebola
authors.initials: A
authors.lastname: Adesanya
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Chang
authors.forename: Peter
authors.initials: P
authors.lastname: Hou
authors.forename: Harry
authors.initials: H
authors.lastname: Anderson
authors.forename: J Jason
authors.initials: JJ
authors.lastname: Hoth
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.forename: Nina T
authors.initials: NT
authors.lastname: Gentile
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.forename: Ednan
authors.initials: E
authors.lastname: Bajwa
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Watkins
authors.forename: Emir
authors.initials: E
authors.lastname: Festic
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Remzi
authors.initials: R
authors.lastname: Iscimen
authors.forename: David A
authors.initials: DA
authors.lastname: Kaufman
authors.forename: Annette M
authors.initials: AM
authors.lastname: Esper
authors.forename: Ruxana
authors.initials: R
authors.lastname: Sadikot
authors.forename: Ivor
authors.initials: I
authors.lastname: Douglas
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sevransky
authors.forename: Michael
authors.initials: M
authors.lastname: Malinchoc
mesh_terms: 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
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