Late-onset moderate to severe acute respiratory distress syndrome is associated with shorter survival and higher mortality: a two-stage association study

• DOI: 10.1007/s00134-016-4638-3
• Publication Date: 2016-12-28T10:12:48Z
• Authors: Ruyang Zhang; Zhaoxi Wang; Paula Tejera; Angela J. Frank; Yongyue Wei; Li Su; Zhaozhong Zhu; Yichen Guo; Feng Chen; Ednan K. Bajwa; B. Taylor Thompson; David C. Christiani
• Keywords: Male; Respiratory Distress Syndrome; Time Factors; Middle Aged; Severity of Illness Index; Survival Analysis; 3. Good health; Intensive Care Units; Random Allocation; Logistic Models; Risk Factors; Odds Ratio; Humans; Female; Prospective Studies; Aged; Proportional Hazards Models

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.