title: Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome.
abstract: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis.
  
  
  
  A prospective, multicenter, observational, descriptive, and validation study.
  
  
  
  A network of multidisciplinary ICUs.
  
  
  
  Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation.
  
  
  
  None.
  
  
  
  Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient's age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort.
  
  
  
  A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.
authors.affiliation: 1CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 2Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain. 3Intensive Care Unit, Hospital General de Ciudad Real, Ciudad Real, Spain. 4Intensive Care Unit, Hospital Universitario Morales Meseguer, Murcia, Spain. 5Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 6Post-Surgical Unit, Department of Anesthesia, Hospital Clínico de Valencia, Valencia, Spain. 7Intensive Care Unit, Hospital Virgen de la Luz, Cuenca, Spain. 8Intensive Care Unit, Hospital Universitario A Coruña, Coruña, Spain. 9Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain. 10Intensive Care Unit, Hospital Universitario Mutua de Terrassa, Barcelona, Spain. 11Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain. 12Intensive Care Unit, Hospital General de León, León, Spain. 13Intensive Care Unit, Hospital Clínico de Valladolid, Valladolid, Spain. 14Intensive Care Unit, Hospital del Bierzo, Ponferrada, León, Spain. 15Research Unit, Hospital Universitario NS de Candelaria, Santa Cruz de Tenerife, Spain. 16Department of Respiratory Care, Massachusetts General Hospital, Boston, MA. 17Department of Anesthesia, Harvard University, Boston, MA.
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ambrós
authors.forename: Juan Alfonso
authors.initials: JA
authors.lastname: Soler
authors.forename: Domingo
authors.initials: D
authors.lastname: Martínez
authors.forename: Carlos
authors.initials: C
authors.lastname: Ferrando
authors.forename: Rosario
authors.initials: R
authors.lastname: Solano
authors.forename: Fernando
authors.initials: F
authors.lastname: Mosteiro
authors.forename: Jesús
authors.initials: J
authors.lastname: Blanco
authors.forename: Carmen
authors.initials: C
authors.lastname: Martín-Rodríguez
authors.forename: María Del Mar
authors.initials: MM
authors.lastname: Fernández
authors.forename: Julia
authors.initials: J
authors.lastname: López
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Díaz-Domínguez
authors.forename: David
authors.initials: D
authors.lastname: Andaluz-Ojeda
authors.forename: Eleuterio
authors.initials: E
authors.lastname: Merayo
authors.forename: Lina
authors.initials: L
authors.lastname: Pérez-Méndez
authors.forename: Rosa Lidia
authors.initials: RL
authors.lastname: Fernández
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood*; D011175:Positive-Pressure Respiration; D018467:Positive-Pressure Respiration, Intrinsic; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012128:Respiratory Distress Syndrome
chemical_list: D010100:Oxygen