The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome-An International Multicenter Observational Study.

Fecha de publicación: 05/01/2022 Fecha Ahead of Print: 05/01/2022

Autores de IIS La Fe

Guido Mazzinari

Autor

Participantes ajenos a IIS La Fe

Valk CMA
Zimatore, Claudio
Pierrakos, Charalampos
Sivakorn, Chaisith
Dechsanga, Jutamas
Grasso, Salvatore
Beenen, Ludo
Bos LDJ
Paulus, Frederique
Schultz, Marcus J.
Pisani, Luigi

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Leader

Óscar Díaz Cambronero

Abstract

Background: The radiographic assessment for lung edema (RALE) score has an association with mortality in patients with acute respiratory distress syndrome (ARDS). It is uncertain whether the RALE scores at the start of invasive ventilation or changes thereof in the next days have prognostic capacities in patients with COVID-19 ARDS. Aims and Objectives: To determine the prognostic capacity of the RALE score for mortality and duration of invasive ventilation in patients with COVID-19 ARDS. Methods: An international multicenter observational study included consecutive patients from 6 ICUs. Trained observers scored the first available chest X-ray (CXR) obtained within 48 h after the start of invasive ventilation ("baseline CXR") and each CXRs thereafter up to day 14 ("follow-up CXR"). The primary endpoint was mortality at day 90. The secondary endpoint was the number of days free from the ventilator and alive at day 28 (VFD-28). Results: A total of 350 CXRs were scored in 139 patients with COVID-19 ARDS. The RALE score of the baseline CXR was high and was not different between survivors and non-survivors (33 [24-38] vs. 30 [25-38], P = 0.602). The RALE score of the baseline CXR had no association with mortality (hazard ratio [HR], 1.24 [95% CI 0.88-1.76]; P = 0.222; area under the receiver operating characteristic curve (AUROC) 0.50 [0.40-0.60]). A change in the RALE score over the first 14 days of invasive ventilation, however, had an independent association with mortality (HR, 1.03 [95% CI 1.01-1.05]; P < 0.001). When the event of death was considered, there was no significant association between the RALE score of the baseline CXR and the probability of being liberated from the ventilator (HR 1.02 [95% CI 0.99-1.04]; P = 0.08). Conclusion: In this cohort of patients with COVID-19 ARDS, with high RALE scores of the baseline CXR, the RALE score of the baseline CXR had no prognostic capacity, but an increase in the RALE score in the next days had an association with higher mortality.

Datos de la publicación

ISSN/ISSNe:: 2296-858X, 2296-858X
Tipo:: Article
Páginas:: 772056-772056
DOI:: 10.3389/fmed.2021.772056
Factor de Impacto:: 1,179 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Valk CMA:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands
Zimatore, Claudio:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
Mazzinari, Guido:: Department of Anaesthesiology and Critical Care, Hospital Universitario y Politecnico la Fe, Valencia, Spain

Instituto de Investigación. Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain
Pierrakos, Charalampos:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Department of Intensive Care, Centre Hospitalier Universitaire Brussels, Brussels, Belgium
Sivakorn, Chaisith:: Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
Dechsanga, Jutamas:: Division of Pulmonary and Critical Care, Department of Medicine, Chonburi Hospital, Chonburi, Thailand
Grasso, Salvatore:: Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
Beenen, Ludo:: Department of Radiology, Amsterdam UMC, Amsterdam, Netherlands
Bos LDJ:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Department of Pulmonology, Amsterdam UMC, Amsterdam, Netherlands
Paulus, Frederique:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
Schultz, Marcus J.:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand

Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Pisani, Luigi:: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands

Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand

Anaesthesia and Intensive Care Unit, Miulli Regional Hospital, Acquaviva delle Fonti, Italy