Department of Medicine, Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, USA.
Thorax. 2021 Dec;76(12):1176-1185. doi: 10.1136/thoraxjnl-2020-215950. Epub 2021 Apr 16.
Although acute respiratory distress syndrome (ARDS) is associated with high mortality, its direct causal link with death is unclear. Clarifying this link is important to justify costly research on prevention of ARDS.
To estimate the attributable mortality, if any, of ARDS.
First, we performed a systematic review and meta-analysis of observational studies reporting mortality of critically ill patients with and without ARDS matched for underlying risk factor. Next, we conducted a survival analysis of prospectively collected patient-level data from subjects enrolled in three intensive care unit (ICU) cohorts to estimate the attributable mortality of critically ill septic patients with and without ARDS using a novel causal inference method.
In the meta-analysis, 44 studies (47 cohorts) involving 56 081 critically ill patients were included. Mortality was higher in patients with versus without ARDS (risk ratio 2.48, 95% CI 1.86 to 3.30; p<0.001) with a numerically stronger association between ARDS and mortality in trauma than sepsis. In the survival analysis of three ICU cohorts enrolling 1203 critically ill patients, 658 septic patients were included. After controlling for confounders, ARDS was found to increase the mortality rate by 15% (95% CI 3% to 26%; p=0.015). Significant increases in mortality were seen for severe (23%, 95% CI 3% to 44%; p=0.028) and moderate (16%, 95% CI 2% to 31%; p=0.031), but not for mild ARDS.
ARDS has a direct causal link with mortality. Our findings provide information about the extent to which continued funding of ARDS prevention trials has potential to impart survival benefit.
CRD42017078313.
虽然急性呼吸窘迫综合征（ARDS）与高死亡率相关，但它与死亡之间的直接因果关系尚不清楚。明确这种联系对于证明预防 ARDS 的昂贵研究是合理的很重要。
估计 ARDS 的归因死亡率（如果有的话）。
首先，我们对报告了患有和不患有 ARDS 的危重病患者死亡率的观察性研究进行了系统回顾和荟萃分析，并对潜在危险因素进行了匹配。接下来，我们对三个重症监护病房（ICU）队列中前瞻性收集的患者水平数据进行了生存分析，以使用一种新的因果推理方法估计患有和不患有 ARDS 的严重感染性休克患者的归因死亡率。
荟萃分析中，纳入了 44 项研究（47 个队列），涉及 56081 名危重病患者。与无 ARDS 的患者相比，患有 ARDS 的患者死亡率更高（风险比 2.48，95%CI 1.86 至 3.30；p<0.001），在创伤患者中 ARDS 与死亡率之间的相关性更强。在三个 ICU 队列的生存分析中，纳入了 1203 名危重病患者，其中 658 名患有败血症。在控制了混杂因素后，发现 ARDS 使死亡率增加了 15%（95%CI 3%至 26%；p=0.015）。严重（23%，95%CI 3%至 44%；p=0.028）和中度（16%，95%CI 2%至 31%；p=0.031）的 ARDS 患者死亡率显著增加，但轻度 ARDS 患者的死亡率没有增加。
ARDS 与死亡率之间存在直接的因果关系。我们的研究结果提供了有关继续资助 ARDS 预防试验在多大程度上有可能带来生存获益的信息。
PROSPERO 注册号：CRD42017078313。
