Comparison of Hospital Mortality and Long-Term Survival in Patients with Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) versus Cardiogenic Pulmonary Edema (CPE).

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Comparison of Hospital Mortality and Long-Term Survival in Patients with Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) versus Cardiogenic Pulmonary Edema (CPE).

Chest. 2014 Dec 4;

Authors: Schmickl CN, Biehl M, Wilson GA, Gajic O

Abstract
Background: Early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE) is important for selecting the most appropriate therapy but the prognostic implications of this distinction have not been studied. Accurate prognostic information is essential for providing appropriate informed consent prior to initiation of mechanical ventilation.
Methods: This is a long term follow-up study of a previously established population-based cohort of critically-ill adult patients with acute pulmonary edema admitted at a tertiary-care center during 2006-2009, in which post-hoc expert review had established ALI vs CPE diagnosis. Using logistic and Cox regression, hospital mortality and long-term survival were compared in ALI vs CPE patients.
Results: Of 328 patients (ALI=155, CPE=173) 240 patients (73%) died during a median follow-up of 160 days. After adjusting for confounders, ALI patients were significantly more likely to die in the hospital (Odds ratio=4.2; 95%-Confidence Interval [CI]= 2.3-7.8; n=325, P<0.001), but among hospital survivors the risk of death during follow-up was the same in both groups (Hazard ratio=1.13, 95%-CI= 0.79-1.62; n=229, P=0.50). Independent predictors of mortality included age and APACHE III score. Results were similar when restricting ALI patients to the subset with acute respiratory distress syndrome (ARDS, Berlin definition). In post-hoc analyses, the mortality rate in hospital survivors compared to the general US population was significantly higher during the first two years but essentially converged by year five.
Conclusions: While hospital mortality is higher in ALI/ARDS compared to CPE patients, long-term survival is similar in hospital survivors from both groups.

PMID: 25474475 [PubMed - as supplied by publisher]

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