scholarly journals Blood eosinophils and mortality in patients with acute respiratory distress syndrome: A propensity score matching analysis

2021 ◽  
Vol 12 (2) ◽  
pp. 131
Author(s):  
Hao-tian Chen ◽  
Jian-feng Xu ◽  
Xiao-xia Huang ◽  
Ni-ya Zhou ◽  
Yong-kui Wang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Propensity Score Matching Analysis ◽  
Blood Eosinophils

scholarly journals Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome: Propensity Score Matching

Membranes ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 393
Author(s):  
Li-Chung Chiu ◽  
Li-Pang Chuang ◽  
Shaw-Woei Leu ◽  
Yu-Jr Lin ◽  
Chee-Jen Chang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Mortality Rate ◽  
Propensity Score ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Membrane Oxygenation

The high mortality rate of patients with severe acute respiratory distress syndrome (ARDS) warrants aggressive clinical intervention. Extracorporeal membrane oxygenation (ECMO) is a salvage therapy for life-threatening hypoxemia. Randomized controlled trials of ECMO for severe ARDS comprise a number of ethical and methodological issues. Therefore, indications and optimal timing for implementation of ECMO, and predictive risk factors for outcomes have not been adequately investigated. We performed propensity score matching to match ECMO-supported and non-ECMO-supported patients at 48 h after ARDS onset for comparisons based on clinical outcomes and hospital mortality. A total of 280 severe ARDS patients were included, and propensity score matching of 87 matched pairs revealed that the 90-d hospital mortality rate was 56.3% in the ECMO group and 74.7% in the non-ECMO group (p = 0.028). Subgroup analysis revealed that greater severity of ARDS, higher airway pressure, or a higher Sequential Organ Failure Assessment score tended to benefit from ECMO treatment in terms of survival. Multivariate logistic regression revealed that hospital mortality was significantly lower among patients who received ECMO than among those who did not. Our findings suggested that early initiation of ECMO (within 48 h) may increase the likelihood of survival for patients with severe ARDS.

Lung-heart pressure index is a risk factor for acute respiratory distress syndrome (ARDS): A machine learning and propensity score-matching study.

2019 ◽  
Author(s):  
Xue-Shu Yu ◽  
Xiao-Jun Pan ◽  
Zhi-Qiang Chen ◽  
Yu-Feng Hu ◽  
Jie Shu ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Random Forest ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Query Language ◽  
Pressure Index ◽  
Better Than

Abstract Background Ventilator-induced lung injury (VILI) and haemodynamic instability play vital roles in acute respiratory distress syndrome (ARDS). The principle of driving pressure (DP) is the response to “volutrauma”, and the mean arterial pressure (MAP) is a haemodynamic systemic manifestation. In this study, we explored a novel lung-heart pressure index (LHPI) based on DP and MAP and explored its prognostic value in patients with ARDS.Methods This is a retrospective study based on the MIMIC-III database. ARDS patients who had undergone mechanical ventilation for more than 48 hours were selected through structured query language. The focus of the study was whether a high LHPI was associated with 30-day mortality and whether its predictive power was better than that of DP and mechanical power (MP). We used random forest, propensity-score matching, and logistic regression to test our hypothesis.Results A total of 448 ICU ARDS patients were enrolled. The mortality rate of ARDS patients was 29.02%. The LHPI was more important than DP and MP in the random forest. A significant adverse effect of high LHPI on 30-day mortality was observed in the high-LHPI group compared to the effect observed in the low-LHPI group (OR=1.86, 95% CI 1.08–3.26, p =0.027). More importantly, LHPI was significantly better than DP (NRI=0.054, 95% CI (0.014-0.094), P=0.008; IDI=0.011, 95% CI (0.002-0.019), P=0.014) and MP (NRI=0.061, 95% CI (0.001-0.122), P=0.049; IDI=0.047, 95% CI (0.022-0.071), P<0.001) in predicting mortality.Conclusions The study showed that the LHPI was a powerful prognostic indicator of 30-day mortality in ARDS patients, and its predictive discrimination was better than that of DP and MP. Further experimental trials are needed to investigate whether adjusting treatment decisions according to the LHPI will significantly improve clinical outcomes.

scholarly journals Short-term survival of acute respiratory distress syndrome patients due to influenza virus infection alone: a cohort study

2020 ◽  
Vol 6 (4) ◽  
pp. 00587-2020
Author(s):  
Arnaud Gacouin ◽  
Mathieu Lesouhaitier ◽  
Florian Reizine ◽  
Charlotte Pronier ◽  
Murielle Grégoire ◽  
...  
Keyword(s):  
Influenza Virus ◽  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Propensity Score Matching ◽  
Distress Syndrome ◽  
Arterial Oxygen ◽  
Term Survival ◽  
The Impact

BackgroundInfluenza virus (IV)-related pathophysiology suggests that the prognosis of acute respiratory distress syndrome (ARDS) due to IV could be different from the prognosis of ARDS due to other causes. However, the impact of IV infection alone on the prognosis of ARDS patients compared to that of patients with other causes of ARDS has been poorly assessed.MethodsWe compared the 28-day survival from the diagnosis of ARDS with an arterial oxygen tension/inspiratory oxygen fraction ratio ≤150 mmHg between patients with and without IV infection alone. Data were collected prospectively and analysed retrospectively. We first performed survival analysis on the whole population; second, patients with IV infection alone were compared with matched pairs using propensity score matching.ResultsThe cohort admitted from October 2009 to March 2020 consisted of 572 patients, including 73 patients (13%) with IV alone. On the first 3 days of mechanical ventilation, nonpulmonary Sequential Organ Failure Assessment scores were significantly lower in patients with IV infection than in the other patients. After the adjusted analysis, IV infection alone remained independently associated with lower mortality at day 28 (hazard ratio 0.51, 95% CI 0.26–0.99, p=0.047). Mortality at day 28 was significantly lower in patients with IV infection alone than in other patients when propensity score matching was used (20% versus 38%, p=0.02).ConclusionsOur results suggest that patients with ARDS following IV infection alone have a significantly better prognosis at day 28 and less severe nonpulmonary organ dysfunction than do those with ARDS from causes other than IV infection alone.

scholarly journals Blood Eosinophils and Mortality in Patients With Acute Respiratory Distress Syndrome: A Propensity Score Matching Analysis

2020 ◽  
Author(s):  
Haotian Chen ◽  
Yue Mao ◽  
Jianfeng Xu ◽  
Xiaoxia Huang ◽  
Niya Zhou ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Eosinophil Count ◽  
Distress Syndrome ◽  
Cox Regression ◽  
Blood Eosinophils ◽  
The Relationship ◽  
Eosinophil Counts

Abstract Background: The effect of blood eosinophils on mortality in acute respiratory distress syndrome (ARDS) patients and whether this effect is impacted by corticosteroids are unclear. This study explored the relationship between blood eosinophils and 28-day mortality in ARDS patients and investigated whether the relationship varied according to corticosteroid use.Methods: The Medical Information Mart for Intensive Care III database was employed to extract data. Patients with ARDS who were 16 years or older, used mechanical ventilation during the ICU stay and stayed in the ICU for at least 48 consecutive hours were screened for inclusion. Cox regression models using the stepwise backward method and propensity score matching (PSM) were employed to assess the relationship between blood eosinophil counts and 28-day mortality.Result: A total of 3372 patients were included, and the 28-day mortality rate was 24.23% (817/3372). The crude 28-day mortality was significantly lower in patients with eosinophil count ≥2% (105/574 vs. 712/2798, p< 0.001) than in those with eosinophil count <2%. In the Cox regression model, the eosinophil count ≥2% showed a significant association with decreased 28-day mortality (hazard ratio (HR) 0.761; 95% confidence interval (CI) =0.620-0.935, p=0.009). In a subgroup analysis, we detected an interactive effect of eosinophils and corticosteroids use (p value for interaction, p=0.006). In the corticosteroid non-use subgroup, eosinophil counts ≥2% were significantly related to decreased 28-day mortality (HR=0.730, 95% CI =0.577-0.923), but the result was non-significant in the corticosteroid non-use subgroup model (p=0.231). A total of 574 well-matched pairs were obtained by a 1:1 matching algorithm after PSM. The 28-day mortality remained significantly lower in the eosinophil count ≥2% group than in the eosinophil count <2% group (105/574 vs 136/574, p=0.025).Conclusions: Higher eosinophil counts are related to lower 28-day mortality in ARDS patients, and this relationship can be counteracted by using corticosteroids.

scholarly journals Comparative Effectiveness of Midazolam, Propofol, and Dexmedetomidine in Patients With or at Risk for Acute Respiratory Distress Syndrome: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
An-Min Hu ◽  
Xiong-Xiong Zhong ◽  
Zhen Li ◽  
Zhong-Jun Zhang ◽  
Hui-Ping Li
Keyword(s):  
At Risk ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Research Database ◽  
Matched Cohort

Background: Sedatives are commonly used in patients with or at risk for acute respiratory distress syndrome (ARDS) during mechanical ventilation. To systematically compare the outcomes of sedation with midazolam, propofol, and dexmedetomidine in patients with or at risk for ARDS.Methods: We developed a dataset of real-world data to enable the comparison of the effectiveness and safety of sedatives and the associated outcomes from the MIMIC-III database and the eICU Collaborative Research database. We performed a systematic study with six cohorts to estimate the relative risks of outcomes among patients administered different sedatives. Propensity score matching was performed to generate a balanced 1:1 matched cohort and to identify potential prognostic factors. The outcomes included hospital mortality, duration of mechanical ventilation, length of intensive care unit stay, length of hospitalization, and likelihood of being discharged home.Results: We performed 60 calibrated analyses among all groups and outcomes with 17,410 eligible patients. Sedation with dexmedetomidine was associated with a lower in-hospital mortality rate than sedation with midazolam and propofol or sedation without dexmedetomidine (p &lt; 0.001). When compared with no sedation, the use of midazolam, propofol or dexmedetomidine was associated with a longer ICU stay and longer hospitalization duration (p &lt; 0.01). Patients treated with midazolam were relatively less likely to be discharged home (p &lt; 0.05).Conclusion: Patients treated with dexmedetomidine had a reduced risk of mortality. These data suggest that dexmedetomidine may be the preferred sedative in patients with or at risk for ARDS.

scholarly journals Early Prone Positioning in Acute Respiratory Distress Syndrome Related to COVID-19: A Propensity Score Analysis from the Multicentric Cohort COVID-ICU network. The ProneCOVID Study.

2021 ◽  
Author(s):  
Christophe LE TERRIER ◽  
Florian Sigaud ◽  
Said Lebbah ◽  
Luc Desmedt ◽  
David Hajage ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Propensity Score Analysis ◽  
Prone Positioning ◽  
Icu Admission ◽  
Significant Difference ◽  
The Impact

Abstract Background Delaying time to prone positioning (PP) may be associated with higher mortality in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). We evaluated the use and the impact of early PP on clinical outcomes in intubated patients hospitalized in intensive care units (ICUs) for COVID-19.Methods All intubated patients with ARDS due to COVID-19 were involved in a secondary analysis from a prospective multicenter cohort study of COVID-ICU network including 149 ICUs across France, Belgian and Switzerland. Patients were followed-up until Day-90. The primary outcome was survival at Day-60. Analysis used a Cox proportional hazard model including a propensity score. Results Among 2137 intubated patients, 1504 (70.4%) were placed in PP during their ICU stay, and 491 (23%) during the first 24 hrs following ICU admission. One hundred and eighty-one patients (36.9%) of the early PP group had a PaO2/FiO2 ratio > 150 mmHg when prone positioning was initiated. Among non-early PP group patients, 1013 (47.4%) patients had finally been placed in PP within a median delay of 3 days after ICU admission. Day-60 mortality in non-early PP group was 34.2% vs. 39.3% in the early PP group (p = 0.038). Day-28 and Day-90 mortality as well as the need for adjunctive therapies were more important in patients with early PP. After propensity score adjustment, no significant difference in survival at Day-60 was found between the two-study groups (HR 1.34 [0.96-1.68], p=0.09 and HR 1.19 [0.998-1.412], p=0.053 in complete case analysis or in multiple imputation analysis, respectively).Conclusions In a large multicentric international cohort of intubated ICU patients with ARDS due to COVID-19, PP has been used frequently as a main treatment. In this study, early PP started within 24 hrs after ICU admission was not associated with a survival benefit compared to PP after day 1.

scholarly journals Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study

2021 ◽  
Author(s):  
Husain S Ali ◽  
Moustafa S Elshafei ◽  
Mohamed O Saad ◽  
Hassan A Mitwally ◽  
Mohammad Al Wraidat ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Propensity Score ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Intravenous Immunoglobulin ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Ivig Therapy ◽  
Routine Care ◽  
Icu Mortality

Abstract Background: Immunomodulatory property of intravenous immunoglobulin (IVIG) has been used to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). However, its use in acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia is not well established.Methods: In this retrospective study, we analyzed electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020, and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28 and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis.Results: Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98- 6.19; P<0.001). Ventilator-free days and ICU-free days at day-28 were lower (P<0.001 for both), and the incidence of AKI was significantly higher (85.6% vs. 67.8%; P=0.001) in the IVIG group.Conclusion: IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized controlled study is required to confirm this observation further.

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