Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study
| Autor: | Ednan K. Bajwa, Zhaozhong Zhu, Paula Tejera, Feng Chen, Yongyue Wei, Li Su, Yichen Guo, B. Taylor Thompson, Angela J. Frank, Zhaoxi Wang, David C. Christiani, Ruyang Zhang |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty ARDS Time Factors Late onset Critical Care and Intensive Care Medicine Severity of Illness Index Article law.invention Random Allocation 03 medical and health sciences 0302 clinical medicine Risk Factors law Internal medicine Odds Ratio medicine Humans Prospective Studies Survival analysis Aged Proportional Hazards Models Respiratory Distress Syndrome Proportional hazards model business.industry Mortality rate Hazard ratio 030208 emergency & critical care medicine Odds ratio Middle Aged medicine.disease Survival Analysis Intensive care unit Surgery Intensive Care Units Logistic Models Editorial 030228 respiratory system Female business |
| Popis: | To evaluate the association between acute respiratory distress syndrome (ARDS) onset time and prognosis. Patients with moderate to severe ARDS (N = 876) were randomly assigned into derivation (N = 520) and validation (N = 356) datasets. Both 28-day and 60-day survival times after ARDS onset were analyzed. A data-driven cutoff point between early- and late-onset ARDS was determined on the basis of mortality risk effects of onset times. We estimated the hazard ratio (HR) and odds ratio (OR) of late-onset ARDS using a multivariate Cox proportional hazards model of survival time and a multivariate logistic regression model of mortality rate, respectively. Late-onset ARDS, defined as onset over 48 h after intensive care unit (ICU) admission (N = 273, 31%), was associated with shorter 28-day survival time: HR = 2.24, 95% CI 1.48–3.39, P = 1.24 × 10−4 (derivation); HR = 2.16, 95% CI 1.33–3.51, P = 1.95 × 10−3 (validation); and HR = 2.00, 95% CI 1.47–2.72, P = 1.10 × 10−5 (combined dataset). Late-onset ARDS was also associated with shorter 60-day survival time: HR = 1.70, 95% CI 1.16–2.48, P = 6.62 × 10−3 (derivation); HR = 1.78, 95% CI 1.15–2.75, P = 9.80 × 10−3 (validation); and HR = 1.59, 95% CI 1.20–2.10, P = 1.22 × 10−3 (combined dataset). Meanwhile, late-onset ARDS was associated with higher 28-day mortality rate (OR = 1.46, 95% CI 1.04–2.06, P = 0.0305) and 60-day mortality rate (OR = 1.44, 95% CI 1.03–2.02, P = 0.0313). Late-onset moderate to severe ARDS patients had both shorter survival time and higher mortality rate in 28-day and 60-day observations. |
| Databáze: | OpenAIRE |
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