title: Aetiology, outcomes & predictors of mortality in acute respiratory distress syndrome from a tertiary care centre in north India.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS.
  
  
  METHODS
  Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study. Demographic, biochemical and ventilatory variables were recorded for each patient. Baseline measurements of serum interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α), procalcitonin (PCT) and high sensitivity C-reactive protein (hsCRP) were performed.
  
  
  RESULTS
  Common causes of ARDS included pneumonia [44/64 (68.7%)], malaria [9/64 (14.1%)] and sepsis [8/64 (12.5%]. Eight of the 64 (12.5%) patients had ARDS due to viral pneumonia. The 28-day mortality was 36/64 (56.2%).Independent predictors of mortality included non-pulmonary organ failure, [Hazard ratio (HR) 7.65; 95% CI 0.98-59.7, P=0.05], Simplified Acute Physiology Score (SAPS-II) [HR 2.36; 95% CI 1.14-4.85, P=0.02] and peak pressure (P peak ) [HR 1.13; 95% CI 1.00-1.30, P = 0.04] at admission.
  
  
  CONCLUSIONS
  Bacterial and viral pneumonia, malaria and tuberculosis resulted in ARDS in a considerable number of patients. Independent predictors of mortality included non-pulmonary organ failure, SAPS II score and P peak at baseline. Elevated levels of biomarkers such as TNF-α, PCT and hsCRP at admission might help in identifying patients at a higher risk of mortality.
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Surendra K
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anunay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Kenneth M. Moser Professor, Department of Medicine, UC San Diego, California, USA.
authors.forename: Atul
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: K T
authors.initials: KT
authors.lastname: Prasad
authors.affiliation: Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Vishnubhatla
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sajal
authors.initials: S
authors.lastname: Ajmani
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Hridesh
authors.initials: H
authors.lastname: Mishra
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Soneja
authors.affiliation: Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shobha
authors.initials: S
authors.lastname: Broor
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007194:India; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008288:Malaria / Q000150:complications / Q000401:mortality* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000821:virology; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000382:microbiology / Q000401:mortality* / Q000821:virology; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D062606:Tertiary Care Centers