title: Lung Injury Prediction Score in Hospitalized Patients at Risk of Acute Respiratory Distress Syndrome.
abstract: OBJECTIVE
  The Lung Injury Prediction Score identifies patients at risk for acute respiratory distress syndrome in the emergency department, but it has not been validated in non-emergency department hospitalized patients. We aimed to evaluate whether Lung Injury Prediction Score identifies non-emergency department hospitalized patients at risk of developing acute respiratory distress syndrome at the time of critical care contact.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Five academic medical centers.
  
  
  METHODS
  Nine hundred consecutive patients (≥ 18 yr old) with at least one acute respiratory distress syndrome risk factor at the time of critical care contact.
  
  
  METHODS
  None.
  
  
  RESULTS
  Lung Injury Prediction Score was calculated using the worst values within the 12 hours before initial critical care contact. Patients with acute respiratory distress syndrome at the time of initial contact were excluded. Acute respiratory distress syndrome developed in 124 patients (13.7%) a median of 2 days (interquartile range, 2-3) after critical care contact. Hospital mortality was 22% and was significantly higher in acute respiratory distress syndrome than non-acute respiratory distress syndrome patients (48% vs 18%; p < 0.001). Increasing Lung Injury Prediction Score was significantly associated with development of acute respiratory distress syndrome (odds ratio, 1.31; 95% CI, 1.21-1.42) and the composite outcome of acute respiratory distress syndrome or death (odds ratio, 1.26; 95% CI, 1.18-1.34). A Lung Injury Prediction Score greater than or equal to 4 was associated with the development of acute respiratory distress syndrome (odds ratio, 4.17; 95% CI, 2.26-7.72), composite outcome of acute respiratory distress syndrome or death (odds ratio, 2.43; 95% CI, 1.68-3.49), and acute respiratory distress syndrome after accounting for the competing risk of death (hazard ratio, 3.71; 95% CI, 2.05-6.72). For acute respiratory distress syndrome development, the Lung Injury Prediction Score has an area under the receiver operating characteristic curve of 0.70 and a Lung Injury Prediction Score greater than or equal to 4 has 90% sensitivity (misses only 10% of acute respiratory distress syndrome cases), 31% specificity, 17% positive predictive value, and 95% negative predictive value.
  
  
  CONCLUSIONS
  In a cohort of non-emergency department hospitalized patients, the Lung Injury Prediction Score and Lung Injury Prediction Score greater than or equal to 4 can identify patients at increased risk of acute respiratory distress syndrome and/or death at the time of critical care contact but it does not perform as well as in the original emergency department cohort.
authors: 1Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.2Division of Anesthesiology, Mayo Clinic, Rochester, MN.3Department of Surgery, University of Michigan Health System, Ann Arbor, MI.4Section of Emergency Medicine and Critical Care, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.5Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, CT.6Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.8Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA.9Department of Medicine, Mayo Clinic, Rochester, MN.
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mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D055370:Lung Injury / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index