Radiologic Assessment of Lung Edema Score as a Predictor of Clinical Outcome in Children with Acute Respiratory Distress Syndrome
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valu able prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. Materials and Methods: The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. Results: Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760–0.848]. In univari able analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18–3.11), and the significance was maintained in multi variable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05–2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519–0.695). Conclusion: The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, espe cially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.
Abstract
Purpose: The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valu able prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. Materials and Methods: The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. Results: Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760–0.848]. In univari able analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18–3.11), and the significance was maintained in multi variable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05–2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519–0.695). Conclusion: The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, espe cially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.
참고문헌 (33)
- Pediatric Acute Lung Injury Consensus Conference Group, "Pediatric acute respiratory distress syndrome : consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference", Pediatr Crit Care Med, 16, pp.428~439 (2015)
- Cheifetz IM, "Pediatric ARDS", Respir Care, 62, pp.718~731 (2017)
- 오탁규, "Trends in Mortality, Treatment, and Costs of Management of Acute Respiratory Distress Syndrome in South Korea: Analysis of Data between 2010 and 2019", Yonsei Medical Journal, 63(5), pp.452~460 (2022), 연세대학교의과대학[DOI]
- Sedhai YR, "Validating measures of disease severity in acute respiratory distress syndrome", Ann Am Thorac Soc, 18, pp.1211~1218 (2021)
- 김병기, "Predictive Role of Lung Injury Prediction Score in the Development of Acute Respiratory Distress Syndrome in Korea", Yonsei Medical Journal, 62(5), pp.417~423 (2021), 연세대학교의과대학[DOI]
- Shubiao Lu, "Establishment and Evaluation of a Simplified Evaluation System of Acute Respiratory Distress Syndrome", Yonsei Medical Journal, 54(4), pp.935~941 (2013), 연세대학교의과대학[DOI]
- Bhalla AK, "The association between ventilatory ratio and mortality in children and young adults", Respir Care, 66, pp.205~212 (2021)
- Kim HS, "Lung compliance and outcomes in patients with acute respiratory distress syndrome receiving ECMO", Ann Thorac Surg, 108, pp.176~182 (2019)
- Huppert LA, "Pathogenesis of acute respiratory distress syndrome", Semin Respir Crit Care Med, 40, pp.31~39 (2019)
- Warren MA, "Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS", Thorax, 73, pp.840~846 (2018)
- Yan YC, "Clinical outcome discrimination in pediatric ARDS by chest radiograph severity scoring", Can Respir J, 2022, pp.9309611~ (2022)
- Smith LS, "Mechanisms of acute respiratory distress syndrome in children and adults : a review and suggestions for future research", Pediatr Crit Care Med, 14, pp.631~643 (2013)
- Ketcham SW, "Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome : a retrospective cohort study", Crit Care, 24, pp.391~ (2020)
- Toma D, "Interobserver agreement and reference intervals for biventricular myocardial deformation in full-term, healthy newborns : a 2D speckle-tracking echocardiography-based strain analysis", Int J Environ Res Public Health, 19, pp.8620~ (2022)
- Fleming S, "Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age : a systematic review of observational studies", Lancet, 377, pp.1011~1018 (2011)
- Iotti G, "Measurements of respiratory mechanics during mechanical ventilation", Hamilton Medical Scientific Library, ~ (1999)
- Rahmatinejad Z, "Internal validation and evaluation of the predictive performance of models based on the PRISM-3(pediatric risk of mortality)and PIM-3(pediatric index of mortality)scoring systems for predicting mortality in pediatric intensive care units(PICUs)", BMC Pediatr, 22, pp.199~ (2022)
- McGraw KO, "Forming inferences about some intraclass correlation coefficients", Psychol Methods, 1, pp.30~ (1996)
- Dog˘an NÖ, "Bland-Altman analysis : a paradigm to understand correlation and agreement", Turk J Emerg Med, 18, pp.139~141 (2018)
- Contal C, "An application of changepoint methods in studying the effect of age on survival in breast cancer", Comput Stat Data Anal, 30, pp.253~270 (1999)
- Harrell FE Jr, "Multivariable prognostic models : issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors", Stat Med, 15, pp.361~387 (1996)
- Koo TK, "A guideline of selecting and reporting intraclass correlation coefficients for reliability research", J Chiropr Med, 15, pp.155~163 (2016)
- Longato E, "A practical perspective on the concordance index for the evaluation and selection of prognostic time-to-event models", J Biomed Inform, 108, pp.103496~ (2020)
- Valentine SL, "Nonpulmonary treatments for pediatric acute respiratory distress syndrome : proceedings from the Pediatric Acute Lung Injury Consensus Conference", Pediatr Crit Care Med, 16(5 Suppl 1), pp.S73~S85 (2015)
- Ingelse SA, "Pediatric acute respiratory distress syndrome : fluid management in the PICU", Front Pediatr, 4, pp.21~ (2016)
- Yoshinori Matsuoka, "Investigation of the Cause of Readmission to the Intensive Care Unit for Patients with Lung Edema or Atelectasis", Yonsei Medical Journal, 49(3), pp.422~428 (2008), 연세대학교의과대학
- Stapleton RD, "Causes and timing of death in patients with ARDS", Chest, 128, pp.525~532 (2005)
- Prescott HC, "Toward smarter lumping and smarter splitting : rethinking strategies for sepsis and acute respiratory distress syndrome clinical trial design", Am J Respir Crit Care Med, 194, pp.147~155 (2016)
- Raissaki M, "Introducing a radiography-based score in children with acute respiratory failure : a cross-sectional study", J Thorac Imaging, 36, pp.294~303 (2021)
- Hu X, "Incidence, management and mortality of acute hypoxemic respiratory failure and acute respiratory distress syndrome from a prospective study of Chinese paediatric intensive care network", Acta Paediatr, 99, pp.715~721 (2010)
- Aakre C, "Prospective validation of a near real-time EHR-integrated automated SOFA score calculator", Int J Med Inform, 103, pp.1~6 (2017)
- Sjoding MW, "Deep learning to detect acute respiratory distress syndrome on chest radiographs : a retrospective study with external validation", Lancet Digit Health, 3, pp.e340~e348 (2021)
- Bauer PR, "Timing of intubation in acute respiratory failure associated with sepsis : a mixed methods study", Mayo Clin Proc, 92, pp.1502~1510 (2017)