GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Crit Care. 2022 Jun 4;26(1):159. doi: 10.1186/s13054-022-04036-7.
Acute respiratory distress syndrome (ARDS) has different phenotypes and distinct short-term outcomes. Patients with non-focal ARDS have a higher short-term mortality than focal ones. The aim of this study was to assess the impact of the morphological phenotypes of ARDS on long-term outcomes.
This was a secondary analysis of the LIVE study, a prospective, randomised control trial, assessing the usefulness of a personalised ventilator setting according to lung morphology in moderate-to-severe ARDS. ARDS was classified as focal (consolidations only in the infero-posterior part of the lungs) or non-focal. Outcomes were assessed using mortality and functional scores for quality of life at the 1-year follow-up.
A total of 124 focal ARDS and 236 non-focal ARDS cases were included. The 1-year mortality was higher for non-focal ARDS than for focal ARDS (37% vs. 24%, p = 0.012). Non-focal ARDS (hazard ratio, 3.44; 95% confidence interval, 1.80-6.59; p < 0.001), age, McCabe score, haematological cancers, SAPS II, and renal replacement therapy were independently associated with 1-year mortality. This difference was driven by mortality during the first 90 days (28 vs. 16%, p = 0.010) but not between 90 days and 1 year (7 vs. 6%, p = 0.591), at which point only the McCabe score was independently associated with mortality. Morphological phenotypes had no impact on patient-reported outcomes.
Lung morphologies reflect the acute phase of ARDS and its short-term impact but not long-term outcomes, which seem only influenced by comorbidities.
NCT02149589; May 29, 2014.
急性呼吸窘迫综合征（ARDS）有不同的表型，且短期预后不同。非局灶性 ARDS 患者的短期死亡率高于局灶性 ARDS 患者。本研究旨在评估 ARDS 的形态表型对长期预后的影响。
这是一项针对 LIVE 研究的二次分析，LIVE 研究是一项前瞻性、随机对照试验，评估根据肺部形态对中重度 ARDS 进行个体化通气设置的有用性。ARDS 分为局灶性（仅在下后肺部有实变）或非局灶性。通过 1 年随访时的死亡率和生活质量功能评分来评估结局。
共纳入 124 例局灶性 ARDS 和 236 例非局灶性 ARDS 患者。非局灶性 ARDS 的 1 年死亡率高于局灶性 ARDS（37%比 24%，p=0.012）。非局灶性 ARDS（风险比，3.44；95%置信区间，1.80-6.59；p<0.001）、年龄、McCabe 评分、血液系统癌症、SAPS II 和肾脏替代治疗与 1 年死亡率独立相关。这种差异是由前 90 天（28%比 16%，p=0.010）的死亡率驱动的，但 90 天至 1 年之间（7%比 6%，p=0.591）的死亡率没有差异，此时只有 McCabe 评分与死亡率独立相关。形态表型对患者报告的结局没有影响。
肺部形态反映了 ARDS 的急性期及其对短期的影响，但不反映长期结局，长期结局似乎仅受合并症影响。
NCT02149589；2014 年 5 月 29 日。
