scholarly journals Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazuya Ichikado ◽  
Kodai Kawamura ◽  
Takeshi Johkoh ◽  
Kiminori Fujimoto ◽  
Ayumi Shintani ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Prognostic Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Disseminated Intravascular Coagulation ◽  
Distress Syndrome ◽  
Fatal Outcome ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Intravascular Coagulation

AbstractThere have been no report of objective clinical characteristics or prognostic factors that predict fatal outcome of acute respiratory distress syndrome (ARDS) since the Berlin definition was published. The aim of this study is to identify clinically available predictors that distinguish between two phenotypes of fatal ARDS due to pneumonia. In total, 104 cases of Japanese patients with pneumonia-induced ARDS were extracted from our prospectively collected database. Fatal cases were divided into early (< 7 days after diagnosis) and late (≥ 7 days) death groups, and clinical variables and prognostic factors were statistically evaluated. Of the 50 patients who died within 180 days, 18 (36%) and 32 (64%) were in the early (median 2 days, IQR [1, 5]) and late (median 16 days, IQR [13, 29]) death groups, respectively. According to multivariate regression analyses, the APACHE II score (HR 1.25, 95%CI 1.12–1.39, p < 0.001) and the disseminated intravascular coagulation score (HR 1.54, 95%CI 1.15–2.04, p = 0.003) were independent prognostic factors for early death. In contrast, late death was associated with high-resolution computed tomography (HRCT) score indicating early fibroproliferation (HR 1.28, 95%CI 1.13–1.42, p < 0.001) as well as the disseminated intravascular coagulation score (HR 1.24, 95%CI 1.01–1.52, p = 0.039). The extent of fibroproliferation on HRCT, and the APACHE II scores along with coagulation abnormalities, should be considered for use in predictive enrichment and personalized medicine for patients with ARDS due to pneumonia.

scholarly journals Clinical Phenotypes from Fatal Cases of Acute Respiratory Distress Syndrome Caused by Pneumonia

2021 ◽  
Author(s):  
Kazuya Ichikado ◽  
Kodai Kawamura ◽  
Takeshi Johkoh ◽  
Kiminori Fujimoto ◽  
Ayumi Shintani ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Death ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Late Death ◽  
Clinical Phenotypes ◽  
Death Group

Abstract Background: The COVID-19 pandemic has renewed interest and discussion about clinical phenotypes of acute respiratory distress syndrome (ARDS). Since the Berlin definition, various clinical disease courses with fatal outcome have been described but early objective indicators predicting distinct clinical courses have remained elusive. Objectives: Identify clinically available predictors that distinguish between two phenotypes of fatal ARDS due to pneumonia.Methods: 104 Japanese patients with pneumonia induced ARDS were extracted from our prospectively collected database. Fatal cases were divided into early (< 7 days after diagnosis) and late death (≥ 7 days) groups and their clinical variables and prognostic factors were statistically evaluated.Results: Of 50 cases, fatal within 180 days, 18 (36%) comprised the early death group (median 2 days, IQR [1, 5]) and 32 (64%), the late death group (median 16 days, IQR [13, 29]). Multivariate regression analyses showed APACHE II score (HR 1.14, 95%CI 1.01-1.28, p 0.047) was the only independent prognostic factor for early death. Late deaths were associated with disseminated intravascular coagulation score (HR 1.30, 95%CI 1.07-1.58, p 0.007), culture sensitivity to initial antimicrobials (HR 3.42, 95%CI 1.86-6.29, p <0.0001), and high-resolution computed tomography (HRCT) score indicating early fibroproliferation. ROC analyses estimated a late death propensity score for HRCT score ≥ 211, of 5.42 (95%CI 1.54–19.12; p 0.008).Conclusions: The extent of fibroproliferation on HRCT, along with coagulation abnormalities and APACHE II scores, should be considered for use in predictive trial enrichment and personalized medicine for patients with ARDS due to pneumonia.

scholarly journals Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Hiroki Iriyama ◽  
◽  
Toshikazu Abe ◽  
Shigeki Kushimoto ◽  
Seitaro Fujishima ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Smoking Status ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Multivariate Logistic Regression ◽  
Admission Source ◽  
Risk Modifiers

Abstract Background Predisposing conditions and risk modifiers instead of causes and risk factors have recently been used as alternatives to identify patients at a risk of acute respiratory distress syndrome (ARDS). However, data regarding risk modifiers among patients with non-pulmonary sepsis is rare. Methods We conducted a secondary analysis of the multicenter, prospective, Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) cohort study that was conducted in 59 intensive care units (ICUs) in Japan during January 2016–March 2017. Adult patients with severe sepsis caused by non-pulmonary infection were included, and the primary outcome was having ARDS, defined as meeting the Berlin definition on the first or fourth day of screening. Multivariate logistic regression modeling was used to identify risk modifiers associated with ARDS, and odds ratios (ORs) and their 95% confidence intervals were reported. The following explanatory variables were then assessed: age, sex, admission source, body mass index, smoking status, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, steroid use, statin use, infection site, septic shock, and acute physiology and chronic health evaluation (APACHE) II score. Results After applying inclusion and exclusion criteria, 594 patients with non-pulmonary sepsis were enrolled, among whom 85 (14.3%) had ARDS. Septic shock was diagnosed in 80% of patients with ARDS and 66% of those without ARDS (p = 0.01). APACHE II scores were higher in patients with ARDS [26 (22–33)] than in those without ARDS [21 (16–28), p < 0.01]. In the multivariate logistic regression model, the following were independently associated with ARDS: ICU admission source [OR, 1.89 (1.06–3.40) for emergency department compared with hospital wards], smoking status [OR, 0.18 (0.06–0.59) for current smoking compared with never smoked], infection site [OR, 2.39 (1.04–5.40) for soft tissue infection compared with abdominal infection], and APACHE II score [OR, 1.08 (1.05–1.12) for higher compared with lower score]. Conclusions Soft tissue infection, ICU admission from an emergency department, and a higher APACHE II score appear to be the risk modifiers of ARDS in patients with non-pulmonary sepsis.

scholarly journals Recombinant Human Thrombomodulin for Pneumonia-Induced Severe Acute Respiratory Distress Syndrome Complicated by Disseminated Intravascular Coagulation in Children: A feasibility study

2019 ◽  
Author(s):  
Naoyuki Hirata ◽  
Dong Tien Ngo ◽  
Phuc Huu Phan ◽  
Akira Ainai ◽  
Thuy Thi Bich Phung ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Feasibility Study ◽  
Disseminated Intravascular Coagulation ◽  
Distress Syndrome ◽  
Laboratory Findings ◽  
Soluble Thrombomodulin ◽  
Intravascular Coagulation ◽  
Cardiopulmonary Support

Abstract Background Recombinant human soluble thrombomodulin (rTM) has been used to treat disseminated intravascular coagulation (DIC). Recent studies have shown the efficacy of rTM through its anti-inflammatory effects for treatment of adults with acute respiratory distress syndrome (ARDS). However, the safety and efficacy of rTM in children with severe ARDS complicated by DIC have not been reported. In this study, we investigated the feasibility of using rTM for the treatment of pneumonia-induced severe ARDS complicated by DIC in children. Methods Six children (age: median 10 month-old) with pneumonia-induced severe ARDS complicated by DIC were enrolled in this feasibility study. rTM (380 U/kg) was administered for a maximum of 6 days, in addition to conventional therapies including cardiopulmonary support, antibiotics and/or antivirus drugs administration, steroid administration and intravenous immunoglobulin after diagnosis of severe ARDS complicated by DIC. After administration of rTM, we measured changes in the plasma TM concentration and evaluated the clinical course, status of DIC and ARDS, and other laboratory findings, including levels of cytokines, chemokines, and biomarkers. Results In all six children, the plasma concentration of TM increased and DIC scores decreased after administration of rTM. Four of the six children recovered from the severe ARDS complicated by DIC after treatment in the pediatric intensive care unit, and were discharged from the hospital with no complications. In surviving children, levels of soluble receptors for advanced glycation end products, interleukin-6, interleukin-8 and monocyte chemotactic protein-1 decreased after administration of rTM. Conclusions The rTM administration is feasible as a therapeutic strategy for children over 2 months with pneumonia-induced severe ARDS complicated by DIC.

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