EpiMed Communications, Abingdon, United Kingdom.
Research & Development, Bayer AG, Berlin, Germany.
Crit Care Explor. 2024 Aug 22;6(9):e1147. doi: 10.1097/CCE.0000000000001147. eCollection 2024 Sep 1.
To provide a comprehensive summary of the published data on cause of death in patients with acute respiratory distress syndrome (ARDS).
PubMed (January 2015 to April 2024), bibliographies of relevant articles, and ARDS Network and Prevention & Early Treatment of Acute Lung Injury (PETAL) network websites.
Observational studies and clinical trials that reported on cause of death in greater than or equal to 30 patients with ARDS, not obtained from death certificates. Animal studies, case reports, review articles, study protocols, and studies in pediatrics were excluded.
Causes of death among ARDS patients who died were extracted and tabulated along with other pertinent study characteristics.
We identified 15 observational studies (nine non-COVID ARDS, five COVID-related ARDS; one both) and five clinical trials (all non-COVID ARDS). Mutually exclusive prespecified categories were used for recording the cause of death in only eight studies although studies differed in the categories included and their definitions. When multiple organ failure was a predetermined category, it was the most common cause of death recorded (~50% of deaths), followed by respiratory causes with proportions varying from 16% to 42% depending on nomenclature (e.g., refractory hypoxemia, pulmonary causes) and definitions. However, the largest observational study in non-COVID ARDS (964 deaths), did not include multiple organ failure as a predetermined category, and found that pulmonary failure (42%) and cardiac failure (37%) were the most common causes of death. In COVID-related ARDS observational studies, pulmonary reasons were the most reported cause of death (up to 88%).
Few studies have reported cause of death in patients with ARDS. In those that do, cause of death categories and definitions used are heterogeneous. Further research is needed to see whether a more rigorous and unified approach to assigning and reporting cause of death in ARDS would help identify more relevant endpoints for the assessment of targeted treatments in clinical trials.
全面总结已发表的关于急性呼吸窘迫综合征（ARDS）患者死因的文献数据。
PubMed（2015 年 1 月至 2024 年 4 月）、相关文章的参考文献以及急性呼吸窘迫综合征网络和预防与早期治疗急性肺损伤（PETAL）网络的网站。
观察性研究和临床试验，报告了大于或等于 30 例 ARDS 患者的死因，且这些数据并非来自死亡证明。排除了动物研究、病例报告、综述文章、研究方案和儿科研究。
提取了 ARDS 患者死亡的死因，并与其他相关研究特征一起制表。
我们确定了 15 项观察性研究（9 项非 COVID-19 ARDS，5 项 COVID-19 相关 ARDS，1 项两者兼有）和 5 项临床试验（均为非 COVID-19 ARDS）。尽管研究在包括的类别及其定义上存在差异，但只有 8 项研究使用了互斥的预设类别来记录死因。当多器官衰竭是一个预定类别时，它是记录的最常见死因（约 50%的死亡），其次是呼吸原因，根据命名法（例如难治性低氧血症、肺部原因）和定义，其比例从 16%到 42%不等。然而，在非 COVID-19 ARDS 中最大的观察性研究（964 例死亡）并未将多器官衰竭作为一个预定类别，发现肺部衰竭（42%）和心力衰竭（37%）是最常见的死因。在 COVID-19 相关 ARDS 的观察性研究中，肺部原因是最常报告的死亡原因（高达 88%）。
很少有研究报告 ARDS 患者的死因。在有报告的研究中，使用的死因类别和定义存在异质性。需要进一步研究，以确定在 ARDS 中更严格和统一的死因分配和报告方法是否有助于确定临床试验中靶向治疗的更相关终点。
