title: Predicting risk of postoperative lung injury in high-risk surgical patients: a multicenter cohort study.
abstract: BACKGROUND
  Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients.
  
  
  METHODS
  This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to assess model performance.
  
  
  RESULTS
  Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and ≥30 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84.
  
  
  CONCLUSIONS
  In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.
authors.affiliation: From the Department of Anesthesiology (D.J.K.), Department of Health Sciences Research (R.K.L., R.E.C.), and Department of Medicine, Division of Pulmonary and Critical Care Medicine (O.G.), Mayo Clinic, Rochester, Minnesota; Department of Surgery (P.K.P.) and Department of Anesthesiology (J.M.B.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Surgery (H.L.A.), St Joseph Mercy Hospital, Ann Arbor, Michigan; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (P.C.H.); Department of Surgery, Wake Forest University Health Sciences, Winston-Salem, North Carolina (J.J.H.); Departme nt of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.K.B.); Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (R.R.B.); Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas (A.A.); Department of Critical Care, Mayo Clinic, Jacksonville, Florida (E.F.); Department of Medicine, Albert Einstein College of Medicine, Bronx, New York (M.N.G.); and Department of Anaesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (D.S.T.).
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Lingineni
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.forename: James M
authors.initials: JM
authors.lastname: Blum
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hou
authors.forename: J Jason
authors.initials: JJ
authors.lastname: Hoth
authors.forename: Harry L
authors.initials: HL
authors.lastname: Anderson
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.forename: Raquel R
authors.initials: RR
authors.lastname: Bartz
authors.forename: Adebola
authors.initials: A
authors.lastname: Adesanya
authors.forename: Emir
authors.initials: E
authors.lastname: Festic
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Talmor
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis* / Q000453:epidemiology*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors
references.citation: Am J Respir Crit Care Med. 2011 Feb 15;183(4):462-70
references.pmid: 20802164
references.citation: Anesthesiology. 2006 Jul;105(1):14-8
references.pmid: 16809989
references.citation: J Am Coll Surg. 2004 Oct;199(4):531-7
references.pmid: 15454134
references.citation: Cardiovasc Surg. 1996 Feb;4(1):15-21
references.pmid: 8634840
references.citation: Crit Care Med. 2012 Aug;40(8):2295-303
references.pmid: 22809905
references.citation: N Engl J Med. 2001 Nov 8;345(19):1368-77
references.pmid: 11794169
references.citation: Crit Care Med. 2000 Sep;28(9):3137-45
references.pmid: 11008971
references.citation: N Engl J Med. 2000 May 4;342(18):1301-8
references.pmid: 10793162
references.citation: N Engl J Med. 2006 Jun 15;354(24):2564-75
references.pmid: 16714767
references.citation: Anaesthesia. 1992 Mar;47(3):267-8
references.pmid: 1566999
references.citation: Dig Dis Sci. 1983 Feb;28(2):110-6
references.pmid: 6825533
references.citation: Crit Care Med. 2011 Nov;39(11):2393-400
references.pmid: 21725238
references.citation: Thorax. 2009 Feb;64(2):121-7
references.pmid: 18988659
references.citation: J Am Coll Surg. 2007 Jun;204(6):1188-98
references.pmid: 17544077
references.citation: Am J Respir Crit Care Med. 2001 Mar;163(4):1002-9
references.pmid: 11282780
references.citation: Am J Respir Crit Care Med. 2010 May 15;181(10):1121-7
references.pmid: 20224063
references.citation: N Engl J Med. 2001 Mar 1;344(9):665-71
references.pmid: 11228282
references.citation: Intensive Care Med. 2007 Apr;33(4):575-90
references.pmid: 17285286
references.citation: Thorax. 2010 Jan;65(1):44-50
references.pmid: 19770169
references.citation: Chest. 2003 Dec;124(6):2341-51
references.pmid: 14665518
references.citation: Am J Respir Crit Care Med. 1995 Feb;151(2 Pt 1):293-301
references.pmid: 7842182
references.citation: Crit Care Med. 2000 Jul;28(7):2187-92
references.pmid: 10921539
references.citation: Crit Care Med. 2008 May;36(5):1518-22
references.pmid: 18434908
references.citation: Ann Intern Med. 2007 Oct 16;147(8):573-7
references.pmid: 17938396
references.citation: Chest. 2009 Apr;135(4):936-943
references.pmid: 19188549
references.citation: JAMA. 1996 Jan 3;275(1):50-4
references.pmid: 8531287
references.citation: Ann Thorac Surg. 2007 Oct;84(4):1085-91; discussion 1091
references.pmid: 17888952
references.citation: Br J Anaesth. 2001 May;86(5):633-8
references.pmid: 11575337
references.citation: Crit Care Med. 2005 Jun;33(6):1191-8
references.pmid: 15942330
references.citation: Am J Respir Crit Care Med. 2003 Apr 1;167(7):1027-35
references.pmid: 12663342
references.citation: BMJ Open. 2012 Sep 04;2(5):
references.pmid: 22952165
references.citation: Am J Clin Oncol. 2008 Aug;31(4):340-4
references.pmid: 18845992
references.citation: Chest. 2001 Mar;119(3):884-8
references.pmid: 11243972
references.citation: New Horiz. 1994 Nov;2(4):488-504
references.pmid: 7804798
references.citation: N Engl J Med. 2013 Aug 1;369(5):428-37
references.pmid: 23902482
references.citation: Intensive Care Med. 2012 Oct;38(10):1573-82
references.pmid: 22926653
references.citation: N Engl J Med. 2011 Apr 7;364(14):1293-304
references.pmid: 21470008
references.citation: World Health Organ Tech Rep Ser. 1968;405:5-37
references.pmid: 4975372
references.citation: Ann Surg. 2000 Aug;232(2):242-53
references.pmid: 10903604
references.citation: Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818-24
references.pmid: 7509706
references.citation: Anesthesiology. 2013 Jan;118(1):19-29
references.pmid: 23221870
references.citation: Crit Care. 2007;11(5):R96
references.pmid: 17784960
references.citation: Chest. 2000 Jan;117(1):163-8
references.pmid: 10631215
references.citation: J Cardiothorac Surg. 2010 Aug 17;5:62
references.pmid: 20716368
references.citation: Ann Intern Med. 1983 May;98(5 Pt 1):593-7
references.pmid: 6846973
references.citation: Eur Respir J. 2011 Mar;37(3):604-9
references.pmid: 20562130
references.citation: Eur J Cardiothorac Surg. 2003 Feb;23(2):201-8
references.pmid: 12559343
references.citation: N Engl J Med. 2010 Sep 16;363(12):1107-16
references.pmid: 20843245
references.citation: Anesthesiology. 2011 Jul;115(1):117-28
references.pmid: 21694510
references.citation: Arch Phys Med Rehabil. 2009 Apr;90(4):628-33
references.pmid: 19345779
references.citation: Anesth Analg. 2003 Dec;97(6):1558-1565
references.pmid: 14633519
references.citation: Crit Care Med. 2002 Sep;30(9):2158-9
references.pmid: 12352065
references.citation: Ann Thorac Surg. 2013 Mar;95(3):1122-9
references.pmid: 23352419
references.citation: Chest. 1999 Jul;116(1 Suppl):74S-82S
references.pmid: 10424602
references.citation: Am J Surg. 1982 Jul;144(1):124-30
references.pmid: 7091520