Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale Clinique, F-75005 Paris, France; and Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France.
Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France.
Respir Care. 2022 Jul;67(7):823-832. doi: 10.4187/respcare.09601. Epub 2022 Apr 19.
The association between dyspnea and mortality has not been demonstrated in the ICU setting. We tested the hypothesis that dyspnea (self-reported respiratory discomfort) or its observational correlates (5-item intensive care Respiratory Distress Observation Scale [IC-RDOS]) assessed on ICU admission would be associated with ICU mortality.
Ancillary analysis of single-center data prospectively collected from 220 communicative ICU subjects allocated to a derivation cohort of 120 subjects and a separate validation cohort of 100 subjects. Dyspnea was assessed dichotomously (yes/no), with a dyspnea visual analog scale (measured in mm), and IC-RDOS was calculated. Multivariate logistic regression was used to identify factors associated with ICU and hospital mortality.
Dyspnea was reported by 69 (58%; median 45 [interquartile range [IQR] 32-60] mm) and 47 (47%; 38 [IQR 26-48] mm) subjects in the derivation and validation cohorts, respectively. IC-RDOS was 2.3 (1.2-3.1) and 2.4 (1.3-2.8), respectively. IC-RDOS values were higher in subjects with dyspnea than in subjects without dyspnea in both the derivation cohort (2.6 [2.2-4.6] vs 1.4 [0.9-2.4], < .001) and the validation cohort (2.6 [2.3-4.4] vs 2.2 [1.0-2.8], < .001). On multivariate analysis of the derivation cohort, admission for hemorrhagic shock (odds ratio 13.98), IC-RDOS (odds ratio 1.77), and Simplified Acute Physiology Score II (odds ratio 1.10) was associated with ICU mortality. Areas under the receiving operating characteristic curve of IC-RDOS to predict ICU mortality were 0.785 and 0.794 in the derivation and validation cohorts, respectively.
IC-RDOS, an observational correlate of dyspnea, but not dyspnea itself, was associated with higher mortality in ICU subjects.
呼吸困难与死亡率之间的关系在 ICU 环境中尚未得到证实。我们检验了这样一个假设，即在 ICU 入院时评估的呼吸困难（自我报告的呼吸不适）或其观察相关指标（5 项 ICU 呼吸窘迫观察量表[IC-RDOS]）与 ICU 死亡率相关。
对前瞻性收集的来自 220 位有沟通能力的 ICU 患者的单中心数据进行辅助分析，这些患者被分配到一个推导队列（120 例）和一个独立的验证队列（100 例）。呼吸困难以二分类（是/否）、呼吸困难视觉模拟量表（以毫米为单位）和 IC-RDOS 进行评估。使用多变量逻辑回归来确定与 ICU 和医院死亡率相关的因素。
在推导队列和验证队列中，分别有 69（58%；中位数 45 [四分位距 [IQR] 32-60]mm）和 47（47%；38 [IQR 26-48]mm）位患者报告有呼吸困难。IC-RDOS 分别为 2.3（1.2-3.1）和 2.4（1.3-2.8）。在推导队列和验证队列中，有呼吸困难的患者的 IC-RDOS 值均高于无呼吸困难的患者（2.6 [2.2-4.6] vs 1.4 [0.9-2.4]，<.001；2.6 [2.3-4.4] vs 2.2 [1.0-2.8]，<.001）。在推导队列的多变量分析中，失血性休克（比值比 13.98）、IC-RDOS（比值比 1.77）和简化急性生理学评分 II（比值比 1.10）与 ICU 死亡率相关。IC-RDOS 预测 ICU 死亡率的接收者操作特征曲线下面积在推导队列和验证队列中分别为 0.785 和 0.794。
IC-RDOS 是呼吸困难的观察相关指标，而不是呼吸困难本身，与 ICU 患者的高死亡率相关。
