Clinical relevance of timing of assessment of ICU mortality in patients with moderate-to-severe Acute Respiratory Distress Syndrome
© 2023. The Author(s)..
Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Scientific reports - 13(2023), 1 vom: 27. Jan., Seite 1543 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Villar, Jesús [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 31.01.2023 Date Revised 14.03.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1038/s41598-023-28824-5 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM35218065X |
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| 520 | |a Mortality is a frequently reported outcome in clinical studies of acute respiratory distress syndrome (ARDS). However, timing of mortality assessment has not been well characterized. We aimed to identify a crossing-point between cumulative survival and death in the intensive care unit (ICU) of patients with moderate-to-severe ARDS, beyond which the number of survivors would exceed the number of deaths. We hypothesized that this intersection would occur earlier in a successful clinical trial vs. observational studies of moderate/severe ARDS and predict treatment response. We conducted an ancillary study of 1580 patients with moderate-to-severe ARDS managed with lung-protective ventilation to assess the relevance and timing of measuring ICU mortality rates at different time-points during ICU stay. First, we analyzed 1303 patients from four multicenter, observational cohorts enrolling consecutive patients with moderate/severe ARDS. We assessed cumulative ICU survival from the time of moderate/severe ARDS diagnosis to ventilatory support discontinuation within 7-days, 28-days, 60-days, and at ICU discharge. Then, we compared these findings to those of a successful randomized trial of 277 moderate/severe ARDS patients. In the observational cohorts, ICU mortality (487/1303, 37.4%) and 28-day mortality (425/1102, 38.6%) were similar (p = 0.549). Cumulative proportion of ICU survivors and non-survivors crossed at day-7; after day-7, the number of ICU survivors was progressively higher compared to non-survivors. Measures of oxygenation, lung mechanics, and severity scores were different between survivors and non-survivors at each point-in-time (p < 0.001). In the trial cohort, the cumulative proportion of survivors and non-survivors in the treatment group crossed before day-3 after diagnosis of moderate/severe ARDS. In clinical ARDS studies, 28-day mortality closely approximates and may be used as a surrogate for ICU mortality. For patients with moderate-to-severe ARDS, ICU mortality assessment within the first week of a trial might be an early predictor of treatment response | ||
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| 700 | 1 | |a González-Martin, Jesús M |e verfasserin |4 aut | |
| 700 | 1 | |a Añón, José M |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrando, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Soler, Juan A |e verfasserin |4 aut | |
| 700 | 1 | |a Mosteiro, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Mora-Ordoñez, Juan M |e verfasserin |4 aut | |
| 700 | 1 | |a Ambrós, Alfonso |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández, Lorena |e verfasserin |4 aut | |
| 700 | 1 | |a Montiel, Raquel |e verfasserin |4 aut | |
| 700 | 1 | |a Vidal, Anxela |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz, Tomás |e verfasserin |4 aut | |
| 700 | 1 | |a Pérez-Méndez, Lina |e verfasserin |4 aut | |
| 700 | 1 | |a Rodríguez-Suárez, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández, Cristina |e verfasserin |4 aut | |
| 700 | 1 | |a Fernández, Rosa L |e verfasserin |4 aut | |
| 700 | 1 | |a Szakmany, Tamas |e verfasserin |4 aut | |
| 700 | 1 | |a Burns, Karen E A |e verfasserin |4 aut | |
| 700 | 1 | |a Steyerberg, Ewout W |e verfasserin |4 aut | |
| 700 | 1 | |a Slutsky, Arthur S |e verfasserin |4 aut | |
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