The Association between Prehospital Vulnerability, ARDS Development, and Mortality among At-Risk Adults. Results from the LIPS-A Clinical Trial.

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.