Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia
Abstract There have been no report of objective clinical characteristics or prognostic factors that predict fatal outcome of acute respiratory distress syndrome (ARDS) since the Berlin definition was published. The aim of this study is to identify clinically available predictors that distinguish bet...
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Nature Portfolio
2021
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oai:doaj.org-article:10a0ad4de40c4551b2289602c8b907772021-12-02T19:16:14ZClinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia10.1038/s41598-021-99540-12045-2322https://doaj.org/article/10a0ad4de40c4551b2289602c8b907772021-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99540-1https://doaj.org/toc/2045-2322Abstract There have been no report of objective clinical characteristics or prognostic factors that predict fatal outcome of acute respiratory distress syndrome (ARDS) since the Berlin definition was published. The aim of this study is to identify clinically available predictors that distinguish between two phenotypes of fatal ARDS due to pneumonia. In total, 104 cases of Japanese patients with pneumonia-induced ARDS were extracted from our prospectively collected database. Fatal cases were divided into early (< 7 days after diagnosis) and late (≥ 7 days) death groups, and clinical variables and prognostic factors were statistically evaluated. Of the 50 patients who died within 180 days, 18 (36%) and 32 (64%) were in the early (median 2 days, IQR [1, 5]) and late (median 16 days, IQR [13, 29]) death groups, respectively. According to multivariate regression analyses, the APACHE II score (HR 1.25, 95%CI 1.12–1.39, p < 0.001) and the disseminated intravascular coagulation score (HR 1.54, 95%CI 1.15–2.04, p = 0.003) were independent prognostic factors for early death. In contrast, late death was associated with high-resolution computed tomography (HRCT) score indicating early fibroproliferation (HR 1.28, 95%CI 1.13–1.42, p < 0.001) as well as the disseminated intravascular coagulation score (HR 1.24, 95%CI 1.01–1.52, p = 0.039). The extent of fibroproliferation on HRCT, and the APACHE II scores along with coagulation abnormalities, should be considered for use in predictive enrichment and personalized medicine for patients with ARDS due to pneumonia.Kazuya IchikadoKodai KawamuraTakeshi JohkohKiminori FujimotoAyumi ShintaniSatoru HashimotoYoshitomo EguchiYuko YasudaKeisuke AnanNaoki ShinguYoshihiko SakataJunpei HisanagaTatsuya NitawakiMiwa IioYuko SekidoKenta NishiyamaKazunori NakamuraMoritaka SugaHidenori IchiyasuTakuro SakagamiNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021) |
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Medicine R Science Q |
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Medicine R Science Q Kazuya Ichikado Kodai Kawamura Takeshi Johkoh Kiminori Fujimoto Ayumi Shintani Satoru Hashimoto Yoshitomo Eguchi Yuko Yasuda Keisuke Anan Naoki Shingu Yoshihiko Sakata Junpei Hisanaga Tatsuya Nitawaki Miwa Iio Yuko Sekido Kenta Nishiyama Kazunori Nakamura Moritaka Suga Hidenori Ichiyasu Takuro Sakagami Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| description |
Abstract There have been no report of objective clinical characteristics or prognostic factors that predict fatal outcome of acute respiratory distress syndrome (ARDS) since the Berlin definition was published. The aim of this study is to identify clinically available predictors that distinguish between two phenotypes of fatal ARDS due to pneumonia. In total, 104 cases of Japanese patients with pneumonia-induced ARDS were extracted from our prospectively collected database. Fatal cases were divided into early (< 7 days after diagnosis) and late (≥ 7 days) death groups, and clinical variables and prognostic factors were statistically evaluated. Of the 50 patients who died within 180 days, 18 (36%) and 32 (64%) were in the early (median 2 days, IQR [1, 5]) and late (median 16 days, IQR [13, 29]) death groups, respectively. According to multivariate regression analyses, the APACHE II score (HR 1.25, 95%CI 1.12–1.39, p < 0.001) and the disseminated intravascular coagulation score (HR 1.54, 95%CI 1.15–2.04, p = 0.003) were independent prognostic factors for early death. In contrast, late death was associated with high-resolution computed tomography (HRCT) score indicating early fibroproliferation (HR 1.28, 95%CI 1.13–1.42, p < 0.001) as well as the disseminated intravascular coagulation score (HR 1.24, 95%CI 1.01–1.52, p = 0.039). The extent of fibroproliferation on HRCT, and the APACHE II scores along with coagulation abnormalities, should be considered for use in predictive enrichment and personalized medicine for patients with ARDS due to pneumonia. |
| format |
article |
| author |
Kazuya Ichikado Kodai Kawamura Takeshi Johkoh Kiminori Fujimoto Ayumi Shintani Satoru Hashimoto Yoshitomo Eguchi Yuko Yasuda Keisuke Anan Naoki Shingu Yoshihiko Sakata Junpei Hisanaga Tatsuya Nitawaki Miwa Iio Yuko Sekido Kenta Nishiyama Kazunori Nakamura Moritaka Suga Hidenori Ichiyasu Takuro Sakagami |
| author_facet |
Kazuya Ichikado Kodai Kawamura Takeshi Johkoh Kiminori Fujimoto Ayumi Shintani Satoru Hashimoto Yoshitomo Eguchi Yuko Yasuda Keisuke Anan Naoki Shingu Yoshihiko Sakata Junpei Hisanaga Tatsuya Nitawaki Miwa Iio Yuko Sekido Kenta Nishiyama Kazunori Nakamura Moritaka Suga Hidenori Ichiyasu Takuro Sakagami |
| author_sort |
Kazuya Ichikado |
| title |
Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| title_short |
Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| title_full |
Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| title_fullStr |
Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| title_full_unstemmed |
Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| title_sort |
clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia |
| publisher |
Nature Portfolio |
| publishDate |
2021 |
| url |
https://doaj.org/article/10a0ad4de40c4551b2289602c8b90777 |
| work_keys_str_mv |
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