Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, New York.
Ann Am Thorac Soc. 2019 Nov;16(11):1399-1404. doi: 10.1513/AnnalsATS.201902-116OC.
No previous studies have examined the role of prehospital vulnerability in acute respiratory distress syndrome (ARDS) development and mortality in an acutely ill adult population. To describe the association between prehospital vulnerability and ) the development of ARDS, ) 28-day mortality, and ) 1-year mortality. This was a longitudinal prospective cohort study nested within the multicenter LIPS-A (Lung Injury Prevention Study-Aspirin) trial. We analyzed 301 participants who completed Vulnerable Elders Survey (VES) at baseline. Multivariable logistic regression and Cox regression analyses were used to describe the association between vulnerability and short-term outcomes (ARDS and 28-day mortality) and long-term outcomes (1-year mortality), respectively. The VES score ranged from 0 to 10 (median [interquartile range], 2.0 [0-6]); 143 (47.5%) fit criteria for prehospital vulnerability (VES ≥ 3). Vulnerability was not significantly associated with ARDS development (10 [7.0%] vulnerable patients developed ARDS as per LIPS-A study criteria vs. 20 [12.7%] without vulnerability; = 0.10; adjusted odds ratio [95% confidence interval (CI)], 0.54 [0.24-1.24]; = 0.15). Nor was vulnerability associated with 28-day mortality (15 [10.5%] vulnerable patients were dead by Day 28 vs. 11 [7.0%] nonvulnerable patients; = 0.28; adjusted odds ratio [95% CI], 0.95 [0.39-2.26]; = 0.90). Vulnerability was significantly associated with 1-year mortality in hospital survivors (35 [26.9%] vs. 13 [9.3%]; adjusted hazard ratio [95% CI], 2.20 [1.10-4.37]; = 0.02). In a population of adults recruited for their high risk of ARDS, prehospital vulnerability, measured by VES, was highly prevalent and strongly associated with 1-year mortality.
先前的研究并未探讨过院前脆弱性在急性呼吸窘迫综合征（ARDS）发展和急性危重病成年患者死亡率中的作用。本研究旨在描述院前脆弱性与）ARDS 的发展、）28 天死亡率和）1 年死亡率之间的关系。这是一项嵌套于多中心 LIPS-A（肺损伤预防研究-阿司匹林）试验中的纵向前瞻性队列研究。我们分析了 301 名在基线时完成脆弱性老年人调查（VES）的参与者。使用多变量逻辑回归和 Cox 回归分析分别描述了脆弱性与短期结局（ARDS 和 28 天死亡率）和长期结局（1 年死亡率）之间的关系。VES 评分范围为 0 至 10（中位数[四分位距]，2.0[0-6]）；143 名（47.5%）符合院前脆弱性标准（VES≥3）。脆弱性与 ARDS 的发生无显著相关性（10 名[7.0%]脆弱性患者按 LIPS-A 研究标准发生 ARDS，20 名[12.7%]无脆弱性患者发生 ARDS； = 0.10；调整后的优势比[95%置信区间（CI）]，0.54[0.24-1.24]； = 0.15）。脆弱性与 28 天死亡率也无相关性（15 名[10.5%]脆弱性患者在第 28 天死亡，11 名[7.0%]无脆弱性患者死亡； = 0.28；调整后的优势比[95%CI]，0.95[0.39-2.26]； = 0.90）。在医院幸存者中，脆弱性与 1 年死亡率显著相关（35 名[26.9%] vs. 13 名[9.3%]；调整后的危险比[95%CI]，2.20[1.10-4.37]； = 0.02）。在一个因 ARDS 风险较高而被招募的成年人群中，通过 VES 测量的院前脆弱性非常普遍，与 1 年死亡率密切相关。
