One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome

Chen Yu Wang, Carolyn S Calfee, Devon W Paul, David R Janz, Addison K May, Hanjing Zhuo, Gordon R Bernard, Michael A Matthay, Lorraine B Ware, Kirsten Neudoerffer Kangelaris, Chen Yu Wang, Carolyn S Calfee, Devon W Paul, David R Janz, Addison K May, Hanjing Zhuo, Gordon R Bernard, Michael A Matthay, Lorraine B Ware, Kirsten Neudoerffer Kangelaris

Abstract

Purpose: Advances in supportive care and ventilator management for acute respiratory distress syndrome (ARDS) have resulted in declines in short-term mortality, but risks of death after survival to hospital discharge have not been well described. Our objective was to quantify the difference between short-term and long-term mortality in ARDS and to identify risk factors for death and causes of death at 1 year among hospital survivors.

Methods: This multi-intensive care unit, prospective cohort included patients with ARDS enrolled between January 2006 and February 2010. We determined the clinical characteristics associated with in-hospital and 1-year mortality among hospital survivors and utilized death certificate data to identify causes of death.

Results: Of 646 patients hospitalized with ARDS, mortality at 1 year was substantially higher (41 %, 95% CI 37-45%) than in-hospital mortality (24%, 95% CI 21-27%), P < 0.0001. Among 493 patients who survived to hospital discharge, the 110 (22%) who died in the subsequent year were older (P < 0.001) and more likely to have been discharged to a nursing home, other hospital, or hospice compared to patients alive at 1 year (P < 0.001). Important predictors of death among hospital survivors were comorbidities present at the time of ARDS, and not living at home prior to admission. ARDS-related measures of severity of illness did not emerge as independent predictors of mortality in hospital survivors.

Conclusions: Despite improvements in short-term ARDS outcomes, 1-year mortality is high, mostly because of the large burden of comorbidities, which are prevalent in patients with ARDS.

Figures

Fig. 1
Fig. 1
Probability of survival to 1 year of follow-up among hospital survivors according to discharge location. Whereas 15 % (34/230) and 13 % (15/115) of patients discharged to home or rehabilitation died in the year of follow-up, respectively, 25 % (19/76) transferred to another hospital, 38 % (19/50) discharged to a nursing home, and 96 % (22/23) discharged to hospice care died. The differences in survival across groups are statistically significant (P < 0.001) driven by significantly increased 1-year mortality among patients discharged to hospice (P < 0.001), nursing home (P < 0.001), and other hospital (P = 0.03) compared to discharge to home
Fig. 2
Fig. 2
Underlying causes of death in patients with ALI/ARDS who died during the hospital stay (gray bars) and those who survived hospitalization but died during the year following enrollment (black bars). In both groups, the most common cause of death was underlying malignancy. No difference is statistically significant

References

    1. The Acute Respiratory Distress Syndrome Network Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–1308.
    1. Sinha P, Flower O, Soni N. Deadspace ventilation: a waste of breath! Intensive Care Med. 2011;37:735–746. doi: 10.1007/s00134-011-2194-4.
    1. Antonelli M, Conti G, Esquinas A, Montini L, Maggiore SM, Bello G, Rocco M, Maviglia R, Pennisi MA, Gonzalez-Diaz G, Meduri GU. A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome. Crit Care Med. 2007;35:18–25. doi: 10.1097/01.CCM.0000251821.44259.F3.
    1. Carrillo A, Gonzalez-Diaz G, Ferrer M, Martinez-Quintana ME, Lopez-Martinez A, Llamas N, Alcazar M, Torres A. Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med. 2012;38:458–466. doi: 10.1007/s00134-012-2475-6.
    1. Piquilloud L, Tassaux D, Bialais E, Lambermont B, Sottiaux T, Roeseler J, Laterre PF, Jolliet P, Revelly JP. Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator interaction during non-invasive ventilation delivered by face mask. Intensive Care Med. 2012;38:1624–1631. doi: 10.1007/s00134-012-2626-9.
    1. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377. doi: 10.1056/NEJMoa010307.
    1. Pronovost PJ, Rinke ML, Emery K, Dennison C, Blackledge C, Berenholtz SM. Interventions to reduce mortality among patients treated in intensive care units. J Crit Care. 2004;19:158–164. doi: 10.1016/j.jcrc.2004.07.003.
    1. Valentin A, Ferdinande P, Improvement EWGoQ Recommendations on basic requirements for intensive care units: structural and organizational aspects. Intensive Care Med. 2011;37:1575–1587. doi: 10.1007/s00134-011-2300-7.
    1. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008;133:1120–1127. doi: 10.1378/chest.07-2134.
    1. Erickson SE, Martin GS, Davis JL, Matthay MA, Eisner MD. Recent trends in acute lung injury mortality: 1996–2005. Crit Care Med. 2009;37:1574–1579. doi: 10.1097/CCM.0b013e31819fefdf.
    1. Sigurdsson MI, Sigvaldason K, Gunnarsson TS, Moller A, Sigurdsson GH. Acute respiratory distress syndrome: nationwide changes in incidence, treatment and mortality over 23 years. Acta Anaesthesiol Scand. 2013;57:37–45. doi: 10.1111/aas.12001.
    1. Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, Holets S, Kallet RH, Liu KD, Macintyre N, Moss M, Schoenfeld D, Steingrub J, Thompson BT. Randomized, placebo-controlled clinical trial of an aerosolized beta-2 agonist for treatment of acute lung injury. Am J Respir Crit Care Med. 2011;184:561–568. doi: 10.1164/rccm.201012-2090OC.
    1. Zimmerman JE, Kramer AA, Knaus WA. Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care. 2013;17:R81. doi: 10.1186/cc12695.
    1. Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR. Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;163:1389–1394. doi: 10.1164/ajrccm.163.6.2005123.
    1. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348:683–693. doi: 10.1056/NEJMoa022450.
    1. Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matte A, Barr A, Mehta S, Mazer CD, Guest CB, Stewart TE, Al-Saidi F, Cooper AB, Cook D, Slutsky AS, Herridge MS. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174:538–544. doi: 10.1164/rccm.200505-693OC.
    1. Heyland DK, Groll D, Caeser M. Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life. Crit Care Med. 2005;33:1549–1556. doi: 10.1097/01.CCM.0000168609.98847.50.
    1. Clermont G, Kong L, Weissfeld LA, Lave JR, Rubenfeld GD, Roberts MS, Connors AF, Jr, Bernard GR, Thompson BT, Wheeler AP, Angus DC, Network NACT. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury. PLoS One. 2011;6:e22512. doi: 10.1371/journal.pone.0022512.
    1. Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Dennison Himmelfarb CR, Desai SV, Shanholtz C, Brower RG, Pronovost PJ. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ. 2012;344:e2124. doi: 10.1136/bmj.e2124.
    1. Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med. 1995;152:1818–1824. doi: 10.1164/ajrccm.152.6.8520742.
    1. Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med. 1998;157:1159–1164. doi: 10.1164/ajrccm.157.4.9704088.
    1. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med. 1998;158:1076–1081. doi: 10.1164/ajrccm.158.4.9802009.
    1. Nuckton TJ, Alonso JA, Kallet RH, Daniel BM, Pittet JF, Eisner MD, Matthay MA. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med. 2002;346:1281–1286. doi: 10.1056/NEJMoa012835.
    1. Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest. 2005;128:525–532. doi: 10.1378/chest.128.2.525.
    1. Cooke CR, Kahn JM, Caldwell E, Okamoto VN, Heckbert SR, Hudson LD, Rubenfeld GD. Predictors of hospital mortality in a population-based cohort of patients with acute lung injury. Crit Care Med. 2008;36:1412–1420. doi: 10.1097/CCM.0b013e318170a375.
    1. Seeley E, McAuley DF, Eisner M, Miletin M, Matthay MA, Kallet RH. Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax. 2008;63:994–998. doi: 10.1136/thx.2007.093658.
    1. Cooke CR, Shah CV, Gallop R, Bellamy S, Ancukiewicz M, Eisner MD, Lanken PN, Localio AR, Christie JD. A simple clinical predictive index for objective estimates of mortality in acute lung injury. Crit Care Med. 2009;37:1913–1920. doi: 10.1097/CCM.0b013e3181a009b4.
    1. Brown LM, Calfee CS, Matthay MA, Brower RG, Thompson BT, Checkley W. A simple classification model for hospital mortality in patients with acute lung injury managed with lung protective ventilation. Crit Care Med. 2011;39:2645–2651. doi: 10.1097/CCM.0b013e31821cb04b.
    1. Villar J, Perez-Mendez L, Blanco J, Anon JM, Blanch L, Belda J, Santos-Bouza A, Fernandez RL, Kacmarek RM, Spanish Initiative for Epidemiology S, Therapies for AN A universal definition of ARDS: the PaO2/FiO2 ratio under a standard ventilatory setting—a prospective, multicenter validation study. Intensive Care Med. 2013;39:583–592. doi: 10.1007/s00134-012-2803-x.
    1. Davidson TA, Rubenfeld GD, Caldwell ES, Hudson LD, Steinberg KP. The effect of acute respiratory distress syndrome on long-term survival. Am J Respir Crit Care Med. 1999;160:1838–1842. doi: 10.1164/ajrccm.160.6.9903058.
    1. Wang CY, Kangelaris KN, Janz, May AK, Z H, Bernard GR, Matthay MA, Calfee CS, Ware LB. Long term mortality in clinical acute lung injury is dramatically higher than hospital mortality (abstract) Am J Respir Crit Care Med. 2012;102:A102.
    1. Siew ED, Ware LB, Gebretsadik T, Shintani A, Moons KG, Wickersham N, Bossert F, Ikizler TA. Urine neutrophil gelatinase-associated lipocalin moderately predicts acute kidney injury in critically ill adults. J Am Soc Nephrol. 2009;20:1823–1832. doi: 10.1681/ASN.2008070673.
    1. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American–European consensus conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994;149:818–824. doi: 10.1164/ajrccm.149.3.7509706.
    1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–2533.
    1. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38:1573–1582. doi: 10.1007/s00134-012-2682-1.
    1. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB. Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007;132:410–417. doi: 10.1378/chest.07-0617.
    1. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138:720–723. doi: 10.1164/ajrccm/138.3.720.
    1. Bernard GR, Wheeler AP, Arons MM, Morris PE, Paz HL, Russell JA, Wright PE. A trial of antioxidants N-acetylcysteine and procysteine in ARDS. The antioxidant in ARDS study group. Chest. 1997;112:164–172. doi: 10.1378/chest.112.1.164.
    1. Quinn J, Kramer N, McDermott D. Validation of the social security death index (SSDI): an important readily-available outcomes database for researchers. West J Emerg Med. 2008;9:6–8.
    1. Wunsch H, Guerra C, Barnato AE, Angus DC, Li G, Linde-Zwirble WT. Three-year outcomes for medicare beneficiaries who survive intensive care. JAMA. 2010;303:849–856. doi: 10.1001/jama.2010.216.
    1. Williams TA, Dobb GJ, Finn JC, Knuiman MW, Geelhoed E, Lee KY, Webb SA. Determinants of long-term survival after intensive care. Crit Care Med. 2008;36:1523–1530. doi: 10.1097/CCM.0b013e318170a405.
    1. Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson LV. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;160:50–56. doi: 10.1164/ajrccm.160.1.9708059.
    1. Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010;153:167–175. doi: 10.7326/0003-4819-153-3-201008030-00007.
    1. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM, Canadian Critical Care Trials Group Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–1304. doi: 10.1056/NEJMoa1011802.
    1. Chiumello D, Taccone P, Berto V, Marino A, Migliara G, Lazzerini M, Gattinoni L. Long-term outcomes in survivors of acute respiratory distress syndrome ventilated in supine or prone position. Intensive Care Med. 2012;38:221–229. doi: 10.1007/s00134-011-2445-4.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel