External Validity of Electronic Sniffers for Automated Recognition of Acute Respiratory Distress Syndrome

Introduction: Automated electronic sniffers may be useful for early detection of acute respiratory distress syndrome (ARDS) for institution of treatment or clinical trial screening. Methods: In a prospective cohort of 2929 critically ill patients, we retrospectively applied published sniffer algorithms for automated detection of acute lung injury to assess their utility in diagnosis of ARDS in the first 4 ICU days. Radiographic full-text reports were searched for “edema” OR (“bilateral” AND “infiltrate”) and a more detailed algorithm for descriptions consistent with ARDS. Patients were flagged as possible ARDS if a radiograph met search criteria and had a PaO2/FiO2 or SpO2/FiO2 of 300 or 315, respectively. Test characteristics of the electronic sniffers and clinical suspicion of ARDS were compared to a gold standard of 2-physician adjudicated ARDS. Results: Thirty percent of 2841 patients included in the analysis had gold standard diagnosis of ARDS. The simpler algorithm had sensitivity for ARDS of 78.9%, specificity of 52%, positive predictive value (PPV) of 41%, and negative predictive value (NPV) of 85.3% over the 4-day study period. The more detailed algorithm had sensitivity of 88.2%, specificity of 55.4%, PPV of 45.6%, and NPV of 91.7%. Both algorithms were more sensitive but less specific than clinician suspicion, which had sensitivity of 40.7%, specificity of 94.8%, PPV of 78.2%, and NPV of 77.7%. Conclusions: Published electronic sniffer algorithms for ARDS may be useful automated screening tools for ARDS and improve on clinical recognition, but they are limited to screening rather than diagnosis because their specificity is poor.

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Renal dysfunction reduces the diagnostic and prognostic value of serum CC16 for acute respiratory distress syndrome in intensive care patients

BMC Pulmonary Medicine ◽

10.1186/s12890-020-01245-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jinle Lin ◽

Wuyuan Tao ◽

Jian Wei ◽

Jian Wu ◽

Wenwu Zhang ◽

...

Keyword(s):

Renal Function ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Normal Renal Function ◽

Predictive Value ◽

Distress Syndrome ◽

Icu Patients ◽

Cutoff Value

Abstract Background Contradictory results regarding changes in serum club cell protein 16 (CC16) levels in patients with acute respiratory distress syndrome (ARDS) have been reported, challenging the value of CC16 as a diagnostic and prognostic marker for ARDS. We have also observed increased serum CC16 levels in patients with renal dysfunction (RD). Therefore, the present study aimed to determine whether RD affects the diagnostic performance of CC16 for ARDS in intensive care unit (ICU) patients. Methods We measured serum CC16 concentrations in 479 ICU patients, who were categorized into six groups according to their diagnoses: control, acute kidney injury (AKI), chronic kidney disease (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The sensitivity, specificity, and cutoff values for serum CC16 were assessed by receiver operating characteristic curve analysis. Results Serum CC16 concentrations were higher in the ARDS group than in the control group, and in ARDS patients with normal renal function, serum CC16 could identify ARDS and predict survival outcomes at 7 and 28 days. However, serum CC16 levels were similar among the ARDS+AKI, ARDS+CKD, AIK, and CKD groups. Consequently, in patients with AKI and/or CKD, the specificity of CC16 for diagnosing ARDS or ARDS+RD decreased from 86.62 to 2.82% or 81.70 to 2.12%, respectively. Consistently, the CC16 cutoff value of 11.57 ng/ml in patients with RD differed from the established values of 32.77–33.72 ng/ml with normal renal function. Moreover, the predictive value of CC16 for mortality in ARDS+RD patients was lost before 7 days but regained by 28 days. Conclusion RD reduces the diagnostic specificity, diagnostic cutoff value, and predictive value for 7-day mortality of serum CC16 for ARDS among ICU patients.

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Predictive Value of Serum β2‑Microglobulin for Outcomes in Patients with Acute Respiratory Distress Syndrome Caused by Bacterial Infection

10.21203/rs.3.rs-668831/v1 ◽

2021 ◽

Author(s):

Na Cui ◽

Xiaokai Feng ◽

Chunguo Jiang ◽

Jing Wang ◽

Liming Zhang

Keyword(s):

Risk Factor ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bacterial Infection ◽

Predictive Value ◽

Independent Risk Factor ◽

Distress Syndrome ◽

Survival Group ◽

Β2 Microglobulin

Abstract Background Acute respiratory distress syndrome (ARDS) is a heterogeneous disease with extremely high mortality. We hypothesized that the serum β2-microglobulin (β2MG) level would be elevated and be an independent risk factor for 28-day mortality in patients with ARDS. Methods We retrospectively enrolled 257 patients with ARDS caused by bacterial infection who were admitted consecutively into the Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital from January 1, 2015 to February 28, 2021. Patients were followed for up to 28 days from diagnosis and were divided into a survival group and non-survival group according to their clinical outcomes. The serum β2MG levels and other clinical data were collected. The relationship between serum β2MG levels and 28-day mortality was explored by performing a Cox regression analysis adjusted for age, updated Charlson comorbidity index, disorders of consciousness, septic shock, albumin level, cardiac troponin I level, procalcitonin level, lactic acid level, prothrombin time, and partial pressure of arterial oxygen/fraction of inspired oxygen ratio. Results In this cohort, 161 patients survived, and 96 patients died within 28 days of diagnosis, yielding a 28-day mortality of 37.4%. The median level of β2MG for all enrolled patients was 4.6 (interquartile range [IQR]: 2.9–8.5) mg/L. Higher β2MG levels were significantly associated with 28-day mortality when the β2MG level was analysed as a continuous variable (hazard ratio [HR]: 1.050; 95% confidence interval [CI]: 1.012–1.091; P = 0.010) and when it was categorized into tertiles (HR: 1.482; 95% CI: 1.069–2.045; P = 0.018). The serum β2MG level exhibited a diagnostic accuracy for predicting mortality that was not inferior to those of the Acute Physiology and Chronic Health Evaluation score (P = 0.153) and Sequential Organ Failure Assessment score (P = 0.114). Conclusions The level of serum β2MG is elevated and is an independent risk factor of 28-day mortality in patients with ARDS, suggesting that it has predictive value for the outcomes of these patients.

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Renal dysfunction decreases specificity and overturns cutoff value of serum CC16 while prohibiting 7-day mortality prediction in diagnosing acute respiratory distress syndrome in intensive care unit.

10.21203/rs.2.20735/v1 ◽

2020 ◽

Author(s):

Jinle Lin ◽

Wuyuan Tao ◽

Jian Wei ◽

Wu Jian ◽

Wenwu Zhang ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Intensive Care ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Renal Dysfunction ◽

Predictive Value ◽

Distress Syndrome ◽

Icu Patients ◽

Cutoff Value

Abstract Background: A contradictory tendency between occurrence of acute respiratory distress syndrome (ARDS) and serum club cell protein 16 (CC16) level, However, renal dysfunction (RD) separately raised serum CC16 in our current observation. The purpose of this study was to find the limitation caused by renal dysfunction in the diagnostic performance of CC16 on ARDS in intensive care unit (ICU) patients. Method: We measured serum CC16 in 479 ICU patients. Patients were divided into six subgroups: control, acute kidney injury (AKI), chronic kidney dysfunction (CKD), ARDS, ARDS+AKI, and ARDS+CKD. The cutoff value, sensitivity and specificity of serum CC16 were assessed by receiver operating characteristic curves. Result: Serum CC16 increased among the ARDS group when compared to the control group, which helps identify ARDS and predicts the outcome in patients with normal renal function. However, level of serum CC16 was similar among ARDS+AKI, ARDS+CKD, AIK and CKD groups. Consequently, when compare to AKI and CKD, specificity for diagnosing whether ARDS or ARDS with renal failure decreased from 86.62% to 2.82% or 81.70% to 2.12%. Consistently, a cutoff value of 11.57 ng/mL was overturned from previously at 32.77 ng/mL or 33.72 ng/mL. Moreover, its predictive value for mortality is prohibited before 7 day but works after 28 day. Conclusion: Renal dysfunction limits the specificity, cutoff point, and predictive value at 7-day mortality of CC16 in diagnosing ARDS among ICU patients.

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Lung Ultrasound Assessment of Focal and Non-focal Lung Morphology in Patients With Acute Respiratory Distress Syndrome

Frontiers in Physiology ◽

10.3389/fphys.2021.730857 ◽

2021 ◽

Vol 12 ◽

Author(s):

Charalampos Pierrakos ◽

Marry R. Smit ◽

Luigi Pisani ◽

Frederique Paulus ◽

Marcus J. Schultz ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Sensitivity And Specificity ◽

Gold Standard ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Lung Morphology

Background: The identification of phenotypes based on lung morphology can be helpful to better target mechanical ventilation of individual patients with acute respiratory distress syndrome (ARDS). We aimed to assess the accuracy of lung ultrasound (LUS) methods for classification of lung morphology in critically ill ARDS patients under mechanical ventilation.Methods: This was a post hoc analysis on two prospective studies that performed LUS and chest computed tomography (CT) scanning at the same time. Expert panels from the two participating centers separately developed two LUS methods for classifying lung morphology based on LUS aeration scores from a 12-region exam (Amsterdam and Lombardy method). Moreover, a previously developed LUS method based on anterior LUS scores was tested (Piedmont method). Sensitivity and specificity of all three LUS methods was assessed in the cohort of the other center(s) by using CT as the gold standard for classification of lung morphology.Results: The Amsterdam and Lombardy cohorts consisted of 32 and 19 ARDS patients, respectively. From these patients, 23 (45%) had focal lung morphology while others had non-focal lung morphology. The Amsterdam method could classify focal lung morphology with a sensitivity of 77% and a specificity of 100%, while the Lombardy method had a sensitivity and specificity of 100 and 61%. The Piedmont method had a sensitivity and specificity of 91 and 75% when tested on both cohorts. With both the Amsterdam and Lombardy method, most patients could be classified based on the anterior regions alone.Conclusion: LUS-based methods can accurately classify lung morphology in invasively ventilated ARDS patients compared to gold standard chest CT. The anterior LUS regions showed to be the most discriminant between focal and non-focal lung morphology, although accuracy increased moderately when lateral and posterior LUS regions were integrated in the method.

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