Stapleton Renee D, Wang Bennet M, Hudson Leonard D, Rubenfeld Gordon D, Caldwell Ellen S, Steinberg Kenneth P
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Box 359762, 325 Ninth Ave, Seattle, WA 98104, USA.
Chest. 2005 Aug;128(2):525-32. doi: 10.1378/chest.128.2.525.
Since the early 1980s, case fatality of patients with ARDS has decreased, and explanations are unclear.
Using identical definitions of ARDS and organ failure, we analyzed consecutive cohorts of patients meeting syndrome criteria at our institution in 1982 (n = 46), 1990 (n = 112), 1994 (n = 99), and 1998 (n = 205) to determine causes and timing of death.
Overall case fatality has decreased from 68% in 1981-1982 to a low of 29% in 1996, plateauing since the mid-1990s (p = 0.001 for trend). Sepsis syndrome with multiple organ failure remains the most common cause of death (30 to 50%), while respiratory failure causes a small percentage (13 to 19%) of deaths. The distribution of causes of death has not changed over time. There was no change in the timing of death during the study periods: 26 to 44% of deaths occurred early (< 72 h after ARDS onset), and 56 to 74% occurred late (> 72 h after ARDS onset). However, the increased survival over the past 2 decades is entirely accounted for by patients who present with trauma and other risk factors for their ARDS, while survival for those patients whose risk factor is sepsis has not changed. Additionally, withdrawal of life support in these patients is now occurring at our institution significantly more frequently than in the past, and median time until death has decreased in patients who have support withdrawn.
While these results do not explain the overall case fatality decline in ARDS, they do indicate that sepsis syndrome remains the leading cause of death and suggest that future therapies to improve survival be targeted at reducing the complications of sepsis.
自20世纪80年代初以来，急性呼吸窘迫综合征（ARDS）患者的病死率有所下降，但其原因尚不清楚。
采用相同的ARDS和器官衰竭定义，我们分析了1982年（n = 46）、1990年（n = 112）、1994年（n = 99）和1998年（n = 205）在我们机构符合综合征标准的连续队列患者，以确定死亡原因和时间。
总体病死率已从1981 - 1982年的68%降至1996年的最低点29%，自20世纪90年代中期以来趋于平稳（趋势p = 0.001）。伴有多器官衰竭的脓毒症综合征仍然是最常见的死亡原因（30%至50%），而呼吸衰竭导致的死亡占比很小（13%至19%）。死亡原因的分布随时间没有变化。在研究期间，死亡时间没有变化：26%至44%的死亡发生在早期（ARDS发病后< 72小时），56%至74%发生在晚期（ARDS发病后> 72小时）。然而，过去20年生存率的提高完全是由伴有创伤和其他ARDS风险因素的患者实现的，而那些风险因素为脓毒症的患者生存率没有变化。此外，在我们机构，这些患者现在撤掉生命支持的情况比过去显著更频繁，并且撤掉支持的患者的中位死亡时间有所缩短。
虽然这些结果不能解释ARDS总体病死率下降的原因，但它们确实表明脓毒症综合征仍然是主要的死亡原因，并建议未来改善生存的治疗应针对减少脓毒症的并发症。
