title: Outcome scoring systems for acute respiratory distress syndrome.
abstract: Acute respiratory distress syndrome (ARDS) is commonly diagnosed in intensive care units (ICUs), often in association with acute kidney injury. In this study, we compared the predictive value of outcome scoring systems: Acute Physiology and Chronic Health Evaluation IV (APACHE IV), earlier APACHE models, Sequential Organ Failure Assessment (SOFA), the Risk of renal failure, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage renal failure (RIFLE) classification, and Acute Lung Injury score in critically ill patients with ARDS. We retrospectively abstracted data from the medical records of 135 critically ill ARDS patients in two medical ICUs of a tertiary care hospital from December 1999 to June 2006. Overall mortality rate was 65% (88/135). Forward conditional logistic regression identified APACHE IV, alveolar-arterial O2 tension difference, age, sepsis, and maximum RIFLE (RIFLEmax) score on ICU days 1 and 3 to be independent predictors of hospital mortality. The area under the receiver operating characteristic curve for the APACHE IV score revealed good fit (Hosmer and Lemeshow goodness-of-fit test results) and discriminative power (area under the receiver operating characteristic curve, 0.792 ± 0.038; P < 0.001). The cumulative survival rates at 6-month follow-up after hospital discharge were significantly (P < 0.001) different among ARDS patients with APACHE IV mortality rate 35% or less and APACHE IV mortality rate higher than 35%. The APACHE IV score and RIFLEmax score are predictors of hospital mortality in ARDS patients, with APACHE IV demonstrating desirable properties of prognostic accuracy.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
authors.forename: Chan-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
authors.forename: Ya-Chung
authors.initials: YC
authors.lastname: Tian
authors.forename: Chang-Chyi
authors.initials: CC
authors.lastname: Jenq
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Chang
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Ji-Tseng
authors.initials: JT
authors.lastname: Fang
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.forename: Ying-Huang
authors.initials: YH
authors.lastname: Tsai
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000473:pathology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007676:Kidney Failure, Chronic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000473:pathology*; D012720:Severity of Illness Index