title: Comparison of hospital mortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema.
abstract: BACKGROUND
  Early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE) is important for selecting the most appropriate therapy, but the prognostic implications of this distinction have not been studied. Accurate prognostic information is essential for providing appropriate informed consent prior to initiation of mechanical ventilation.
  
  
  METHODS
  This is a long-term follow-up study of a previously established population-based cohort of critically ill adult patients with acute pulmonary edema admitted at a tertiary-care center during 2006 to 2009, in which post hoc expert review had established ALI vs CPE diagnosis. Using logistic and Cox regression, hospital mortality and long-term survival were compared in patients with ALI vs patients with CPE.
  
  
  RESULTS
  Of 328 patients (ALI = 155, CPE = 173), 240 patients (73%) died during a median follow-up of 160 days. After adjusting for confounders, patients with ALI were significantly more likely to die in the hospital (OR = 4.2, 95% CI = 2.3-7.8, n = 325, P < .001), but among hospital survivors the risk of death during follow-up was the same in both groups (hazard ratio = 1.13, 95% CI = 0.79-1.62, n = 229, P = .50). Independent predictors of mortality included age and APACHE (Acute Physiology and Chronic Health Evaluation) III score. Results were similar when restricting patients with ALI to the subset with ARDS (Berlin definition). In post hoc analyses, the mortality rate in hospital survivors compared with the general US population was significantly higher during the first 2 years but essentially converged by year five.
  
  
  CONCLUSIONS
  Although hospital mortality is higher in patients with ALI/ARDS compared with patients with CPE, long-term survival is similar in hospital survivors from both groups.
authors.affiliation: M.E.T.R.I.C. (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Division of Pulmonary and Critical Care Medicine, University Witten-Herdecke, Witten, Germany. Electronic address: christopher.schmickl@mail.harvard.edu.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Schmickl
authors.affiliation: M.E.T.R.I.C. (Multidisciplinary Epidemiology and Translational Research in Intensive Care), Division of Pulmonary and Critical Care Medicine, Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Michelle
authors.initials: M
authors.lastname: Biehl
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wilson
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D018806:APACHE; D055371:Acute Lung Injury / Q000175:diagnosis / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis / Q000401:mortality*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate