The effect of demographics and patient location on the outcome of patients with acute respiratory distress syndrome.

OBJECTIVE

Outcome of acute respiratory distress syndrome (ARDS) in relation to age, gender, race, pre-Intensive Care Unit (ICU) location, and type of ICU.

METHODS

Retrospective cohort study of patients enrolled in the ARDS network randomized controlled trials.

RESULTS

A total of 2914 patients were included in these trials. Outcomes were adjusted to baseline covariates including APACHE III score, vasopressor use, cause of lung injury, lung injury score, diabetes, cancer status, body mass index, and study ID. Older patients had significantly higher mortality at both 28- and 60-day (odds ratio [OR] 2.59 [95% confidence interval [CI]: 2.12-3.18] < 0.001 and 2.79, 95% CI: 2.29-3.39, < 0.001, respectively); less ICU and ventilator free days (relative risk [RR] 0.92, 95% CI: 0.87-0.96, < 0.001 and 0.92, 95% CI: 0.88-0.96, < 0.001, respectively). For preadmission location, the 28- and 60-day mortality were lower if the patient was admitted from the operating room (OR)/recovery room (OR 0.65, 95% CI: 0.44-0.95, = 0.026; and OR = 0.66, 95% CI: 0.46-0.95, = 0.025, respectively) or emergency department (OR = 0.78, 95% CI: 0.61-0.99, = 0.039; and OR = 0.71, 95% CI: 0.56-0.89, = 0.004, respectively), but no statistical differences in ICU and ventilator free days between different preadmission locations. Races other than white and black had a statistically higher mortality (28- and 60-day mortality: OR = 1.47, 95% CI: 1.09-1.98, = 0.011; and OR 1.53, 95% CI: 1.15-2.04, = 0.004, respectively). Between whites and blacks, females and males there were no statistically significant differences in all outcomes.

CONCLUSION

Older patients and races other than blacks and whites have higher mortality associated with ARDS. Mortality is affected by patients preadmission location. There are no differences in outcome in relation to the type of ICU, gender, or between blacks and whites.