title: One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome.
abstract: OBJECTIVE
  Advances in supportive care and ventilator management for acute respiratory distress syndrome (ARDS) have resulted in declines in short-term mortality, but risks of death after survival to hospital discharge have not been well described. Our objective was to quantify the difference between short-term and long-term mortality in ARDS and to identify risk factors for death and causes of death at 1 year among hospital survivors.
  
  
  METHODS
  This multi-intensive care unit, prospective cohort included patients with ARDS enrolled between January 2006 and February 2010. We determined the clinical characteristics associated with in-hospital and 1-year mortality among hospital survivors and utilized death certificate data to identify causes of death.
  
  
  RESULTS
  Of 646 patients hospitalized with ARDS, mortality at 1 year was substantially higher (41 %, 95% CI 37-45%) than in-hospital mortality (24%, 95% CI 21-27%), P < 0.0001. Among 493 patients who survived to hospital discharge, the 110 (22%) who died in the subsequent year were older (P < 0.001) and more likely to have been discharged to a nursing home, other hospital, or hospice compared to patients alive at 1 year (P < 0.001). Important predictors of death among hospital survivors were comorbidities present at the time of ARDS, and not living at home prior to admission. ARDS-related measures of severity of illness did not emerge as independent predictors of mortality in hospital survivors.
  
  
  CONCLUSIONS
  Despite improvements in short-term ARDS outcomes, 1-year mortality is high, mostly because of the large burden of comorbidities, which are prevalent in patients with ARDS.
authors.affiliation: Department of Internal Medicine, Taichung Veteran General Hospital, Taichung, Taiwan.
authors.forename: Chen Yu
authors.initials: CY
authors.lastname: Wang
authors.forename: Carolyn S
authors.initials: CS
authors.lastname: Calfee
authors.forename: Devon W
authors.initials: DW
authors.lastname: Paul
authors.forename: David R
authors.initials: DR
authors.lastname: Janz
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.forename: Hanjing
authors.initials: H
authors.lastname: Zhuo
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Kirsten Neudoerffer
authors.initials: KN
authors.lastname: Kangelaris
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D003401:Creatine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000401:mortality*; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors
chemical_list: D003401:Creatine