Internal Medicine Residency Program, University of Pittsburgh Medical Center McKeesport, USA.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Crit Care. 2020 Apr;56:222-228. doi: 10.1016/j.jcrc.2020.01.012. Epub 2020 Jan 13.
To assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.
We quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.
The RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002).
The RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation.
评估急性呼吸窘迫综合征（ARDS）患者的胸部 X 光片（CXR）中放射水肿的纵向演变，并研究其与预后生物标志物、ARDS 亚表型和结局的关系。
我们使用放射学肺水肿评分（RALE）对 ARDS 或心源性肺水肿（对照组）患者的 CXR 上的放射水肿进行量化，评分时间为插管当天及之后 10 天。我们测量了基线血浆生物标志物并记录了临床变量。
RALE 评分在 129 名患者的 488 张 CXR 上的观察者间一致性良好（r=0.83，p<0.0001），与对照组（n=21，p=0.01）相比，ARDS 患者（n=108）的 RALE 评分更高。基线 RALE 评分与 ARDS 患者中末端糖基化终产物受体（RAGE）的水平呈正相关（p<0.05）。基线 RALE 评分不能预测 30 天或 90 天的生存率。持续升高的 RALE 评分与需要机械通气时间延长有关（p=0.002）。
RALE 评分易于实施，观察者间可靠性高。纵向 RALE 评分似乎是一种可重复的方法，可用于跟踪 ARDS 患者放射水肿的演变，并可能预测需要长时间机械通气。
