title: The PRESERVE mortality risk score and analysis of long-term outcomes after extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.
abstract: OBJECTIVE
  This study was designed to identify factors associated with death by 6 months post-intensive care unit (ICU) discharge and to develop a practical mortality risk score for extracorporeal membrane oxygenation (ECMO)-treated acute respiratory distress syndrome (ARDS) patients. We also assessed long-term survivors' health-related quality of life (HRQL), respiratory symptoms, and anxiety, depression and post-traumatic stress disorder (PTSD) frequencies.
  
  
  METHODS
  Data from 140 ECMO-treated ARDS patients admitted to three French ICUs (2008-2012) were analyzed. ICU survivors contacted >6 months post-ICU discharge were assessed for HRQL, psychological and PTSD status.
  
  
  RESULTS
  Main ARDS etiologies were bacterial (45%), influenza A[H₁N₁] (26%) and post-operative (17%) pneumonias. Six months post-ICU discharge, 84 (60%) patients were still alive. Based on multivariable logistic regression analysis, the PRESERVE (PRedicting dEath for SEvere ARDS on VV-ECMO) score (0-14 points) was constructed with eight pre-ECMO parameters, i.e. age, body mass index, immunocompromised status, prone positioning, days of mechanical ventilation, sepsis-related organ failure assessment, plateau pressure andpositive end-expiratory pressure. Six-month post-ECMO initiation cumulative probabilities of survival were 97, 79, 54 and 16% for PRESERVE classes 0-2, 3-4, 5-6 and ≥7 (p < 0.001), respectively. HRQL evaluation in 80% of the 6-month survivors revealed satisfactory mental health but persistent physical and emotional-related difficulties, with anxiety, depression or PTSD symptoms reported, by 34, 25 or 16%, respectively.
  
  
  CONCLUSIONS
  The PRESERVE score might help ICU physicians select appropriate candidates for ECMO among severe ARDS patients. Future studies should also focus on physical and psychosocial rehabilitation that could lead to improved HRQL in this population.
authors.affiliation: Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Service de Réanimation Médicale, Groupe Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47, bd de l'Hôpital, 75651, Paris CEDEX 13, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.forename: Hadrien
authors.initials: H
authors.lastname: Rozé
authors.forename: Xavier
authors.initials: X
authors.lastname: Repesse
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bréchot
authors.forename: Ania
authors.initials: A
authors.lastname: Nieszkowska
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.forename: Alexandre
authors.initials: A
authors.lastname: Ouattara
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality* / Q000523:psychology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology*; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data
references.citation: JAMA. 1999 Jan 27;281(4):354-60
references.pmid: 9929089
references.citation: Crit Care Med. 1998 Apr;26(4):651-9
references.pmid: 9559601
references.citation: Chest. 2009 Mar;135(3):678-687
references.pmid: 19265087
references.citation: JAMA. 1963 Sep 21;185:914-9
references.pmid: 14044222
references.citation: Gerontologist. 1969 Autumn;9(3):179-86
references.pmid: 5349366
references.citation: Intensive Care Med. 2012 Feb;38(2):210-20
references.pmid: 22147116
references.citation: Crit Care Med. 2003 May;31(5):1373-81
references.pmid: 12771605
references.citation: Respir Med. 1991 Sep;85 Suppl B:25-31; discussion 33-7
references.pmid: 1759018
references.citation: Crit Care Med. 2011 May;39(5):1029-35
references.pmid: 21336134
references.citation: Presse Med. 2011 Dec;40(12 Pt 2):e595-603
references.pmid: 22078086
references.citation: Acta Anaesthesiol Scand. 2009 Apr;53(4):489-95
references.pmid: 19226296
references.citation: N Engl J Med. 2010 Sep 16;363(12):1107-16
references.pmid: 20843245
references.citation: Curr Opin Crit Care. 2012 Feb;18(1):99-104
references.pmid: 22186218
references.citation: Lancet. 2009 Oct 17;374(9698):1351-63
references.pmid: 19762075
references.citation: Clin Infect Dis. 2012 Dec;55(12):1633-41
references.pmid: 22990851
references.citation: Intensive Care Med. 2011 Sep;37(9):1447-57
references.pmid: 21732167
references.citation: JAMA. 2009 Nov 4;302(17):1888-95
references.pmid: 19822628
references.citation: Crit Care Med. 2010 Jul;38(7):1554-61
references.pmid: 20473149
references.citation: Intensive Care Med. 2006 Aug;32(8):1115-24
references.pmid: 16783553
references.citation: Crit Care Med. 2001 Mar;29(3):573-80
references.pmid: 11373423
references.citation: N Engl J Med. 2000 May 4;342(18):1301-8
references.pmid: 10793162
references.citation: N Engl J Med. 2013 Jun 6;368(23):2159-68
references.pmid: 23688302
references.citation: Arch Intern Med. 2007 Jun 25;167(12):1312-20
references.pmid: 17592106
references.citation: J Clin Epidemiol. 1998 Nov;51(11):1013-23
references.pmid: 9817119
references.citation: Chest. 2012 Sep;142(3):583-592
references.pmid: 22948576
references.citation: Ann Surg. 2004 Oct;240(4):595-605; discussion 605-7
references.pmid: 15383787
references.citation: Intensive Care Med. 2010 Apr;36(4):585-99
references.pmid: 20130832
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Crit Care Med. 2000 Jul;28(7):2293-9
references.pmid: 10921555
references.citation: Intensive Care Med. 2009 Dec;35(12):2105-14
references.pmid: 19768656
references.citation: ASAIO J. 2005 Jan-Feb;51(1):26-9
references.pmid: 15745130
references.citation: N Engl J Med. 2011 Nov 17;365(20):1905-14
references.pmid: 22087681
references.citation: Intensive Care Med. 2013 May;39(5):838-46
references.pmid: 23291732
references.citation: Am J Respir Crit Care Med. 2013 Feb 1;187(3):276-85
references.pmid: 23155145
references.citation: Crit Care. 2012 Oct 19;16(5):R202
references.pmid: 23082772
references.citation: N Engl J Med. 2011 Apr 7;364(14):1293-304
references.pmid: 21470008
references.citation: N Engl J Med. 2013 Feb 28;368(9):806-13
references.pmid: 23339638
references.citation: Psychosom Med. 1979 May;41(3):209-18
references.pmid: 472086
references.citation: Crit Care. 2009;13(6):R205
references.pmid: 20017915
references.citation: Crit Care Med. 2005 Jul;33(7):1549-56
references.pmid: 16003061
references.citation: Crit Care. 2012 Dec 18;16(6):R235
references.pmid: 23249446
references.citation: Crit Care Med. 2013 Jul;41(7):1616-26
references.pmid: 23563585
references.citation: N Engl J Med. 2003 Feb 20;348(8):683-93
references.pmid: 12594312
references.citation: Ann Intern Med. 2011 Mar 15;154(6):373-83
references.pmid: 21403073
references.citation: JAMA. 2011 Oct 19;306(15):1659-68
references.pmid: 21976615
references.citation: Am J Respir Crit Care Med. 2012 Mar 1;185(5):517-24
references.pmid: 22161158
references.citation: Intensive Care Med. 2006 Oct;32(10):1627-31
references.pmid: 16874497
references.citation: Crit Care Med. 2010 Jan;38(1):38-44
references.pmid: 19789455
references.citation: Curr Opin Crit Care. 2012 Oct;18(5):527-32
references.pmid: 22914430