Moss M, Goodman P L, Heinig M, Barkin S, Ackerson L, Parsons P E
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, CO, USA.
Crit Care Med. 1995 Oct;23(10):1629-37. doi: 10.1097/00003246-199510000-00006.
Over the last few years, new definitions of the adult respiratory distress syndrome (ARDS) have been introduced that potentially identify patients earlier in their course of acute lung injury. However, these definitions have never been compared with any of the older and potentially stricter definitions of ARDS to determine if similar patients are eventually identified. We compared new definitions of ARDS--as represented by the Lung Injury Score, a modified Lung Injury Score, and the American-European Consensus Conference definition--against a stricter definition of ARDS to determine their accuracy.
Prospective.
Intensive care unit (ICU) patients in a tertiary, university-affiliated city hospital.
ICU patients with clearly defined at-risk diagnoses for ARDS (group 1, n = 111) and general medical ICU patients without clearly defined at-risk diagnoses for ARDS (group 2, n = 125).
Measurements of hypoxemia, static respiratory system compliance, positive end-expiratory pressure, radiographic changes, and general demographic information were collected. The sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy of all three new definitions were determined. Accuracy was defined as the true-positive plus the true-negative results divided by the total number of patients. When compared with a stricter definition of ARDS, all three definitions maintained a high degree of accuracy in those patients with a clearly defined at-risk diagnosis (group 1): Lung Injury Score 90.0% (95% confidence interval 84-96); modified Lung Injury Score 97.3% (95% confidence interval 94-100), and the American-European Consensus Conference definition 97.3% (95% confidence interval 94-100). For these at-risk patients, the accuracy of the modified Lung Injury Score and the American-European Consensus Conference definition was significantly better than the Lung Injury Score when compared with the strict definition (p = .027 for both comparisons). Although all three definitions maintained an accuracy of > 90% for general medical ICU patients (group 2), the low frequency of ARDS in these patients (3.4%) produced a low positive-predictive value for all three definitions.
We conclude that the Lung Injury Score, the modified Lung Injury Score, and the American-European Consensus Conference definition identify similar patients, provided that these methods are applied to patients with clearly defined at-risk diagnoses for ARDS.
在过去几年中，成人呼吸窘迫综合征（ARDS）引入了新定义，这可能使患者在急性肺损伤病程中得到更早识别。然而，这些新定义从未与任何旧的、可能更严格的ARDS定义进行比较，以确定最终识别出的患者是否相似。我们将ARDS的新定义——以肺损伤评分、改良肺损伤评分以及欧美共识会议定义为代表——与更严格的ARDS定义进行比较，以确定其准确性。
前瞻性研究。
一所大学附属的三级城市医院的重症监护病房（ICU）。
有明确ARDS风险诊断的ICU患者（第1组，n = 111）和无明确ARDS风险诊断的普通内科ICU患者（第2组，n = 125）。
收集低氧血症、静态呼吸系统顺应性、呼气末正压、影像学改变及一般人口统计学信息。确定所有三种新定义的敏感性、特异性、阳性预测值、阴性预测值及准确性。准确性定义为真阳性结果加真阴性结果除以患者总数。与更严格的ARDS定义相比，在有明确风险诊断的患者（第1组）中，所有三种定义均保持了较高的准确性：肺损伤评分为90.0%（95%置信区间84 - 96）；改良肺损伤评分为97.3%（95%置信区间94 - 100），欧美共识会议定义为97.3%（95%置信区间94 - 100）。对于这些有风险的患者，与严格定义相比，改良肺损伤评分和欧美共识会议定义的准确性显著优于肺损伤评分（两项比较p值均为0.027）。虽然所有三种定义对普通内科ICU患者（第2组）的准确性均保持> 90%，但这些患者中ARDS的发生率较低（3.4%），导致所有三种定义的阳性预测值均较低。
我们得出结论，肺损伤评分、改良肺损伤评分和欧美共识会议定义识别出的患者相似，前提是这些方法应用于有明确ARDS风险诊断的患者。
