TY - JOUR
T1 - Prognostic Value of the Radiographic Assessment of Lung Edema Score in Mechanically Ventilated ICU Patients
AU - Filippini, Daan F. L.
AU - Hagens, Laura A.
AU - Heijnen, Nanon F. L.
AU - Zimatore, Claudio
AU - Atmowihardjo, Leila N.
AU - Schnabel, Ronny M.
AU - Schultz, Marcus J.
AU - Bergmans, Dennis C. J. J.
AU - Bos, Lieuwe D. J.
AU - Smit, Marry R.
N1 - Funding Information: M.J.S. is partially employed by Medical Affairs, Hamilton Medical AG. L.D.J.B. provided consultancy and advisory services for Sobi, Scailyte, Santhera, Janssen&Janssen, Exvastat, Pfizer and Astra Zeneca, all paid to the institution. L.D.J.B. received grants from Health Holland, Dutch Lung Foundation (longfonds), ZonMW, Santhera, Innovative medicine initiative and Amsterdam UMC, all paid to the institution. The other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher Copyright: © 2023 by the authors.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - Introduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU) with respiratory failure not due to ARDS, a variable degree of lung edema is observed as well. We aimed to evaluate the prognostic value of RALE in mechanically ventilated ICU patients. Methods: Secondary analysis of patients enrolled in the ‘Diagnosis of Acute Respiratory Distress Syndrome’ (DARTS) project with an available chest X-ray (CXR) at baseline. Where present, additional CXRs at day 1 were analysed. The primary endpoint was 30-day mortality. Outcomes were also stratified for ARDS subgroups (no ARDS, non-COVID-ARDS and COVID-ARDS). Results: 422 patients were included, of which 84 had an additional CXR the following day. Baseline RALE scores were not associated with 30-day mortality in the entire cohort (OR: 1.01, 95% CI: 0.98–1.03, p = 0.66), nor in subgroups of ARDS patients. Early changes in RALE score (baseline to day 1) were only associated with mortality in a subgroup of ARDS patients (OR: 1.21, 95% CI: 1.02–1.51, p = 0.04), after correcting for other known prognostic factors. Conclusions: The prognostic value of the RALE score cannot be extended to mechanically ventilated ICU patients in general. Only in ARDS patients, early changes in RALE score were associated with mortality.
AB - Introduction: The Radiographic Assessment of Lung Edema (RALE) score provides a semi-quantitative measure of pulmonary edema. In patients with acute respiratory distress syndrome (ARDS), the RALE score is associated with mortality. In mechanically ventilated patients in the intensive care unit (ICU) with respiratory failure not due to ARDS, a variable degree of lung edema is observed as well. We aimed to evaluate the prognostic value of RALE in mechanically ventilated ICU patients. Methods: Secondary analysis of patients enrolled in the ‘Diagnosis of Acute Respiratory Distress Syndrome’ (DARTS) project with an available chest X-ray (CXR) at baseline. Where present, additional CXRs at day 1 were analysed. The primary endpoint was 30-day mortality. Outcomes were also stratified for ARDS subgroups (no ARDS, non-COVID-ARDS and COVID-ARDS). Results: 422 patients were included, of which 84 had an additional CXR the following day. Baseline RALE scores were not associated with 30-day mortality in the entire cohort (OR: 1.01, 95% CI: 0.98–1.03, p = 0.66), nor in subgroups of ARDS patients. Early changes in RALE score (baseline to day 1) were only associated with mortality in a subgroup of ARDS patients (OR: 1.21, 95% CI: 1.02–1.51, p = 0.04), after correcting for other known prognostic factors. Conclusions: The prognostic value of the RALE score cannot be extended to mechanically ventilated ICU patients in general. Only in ARDS patients, early changes in RALE score were associated with mortality.
KW - ARDS
KW - RALE score
KW - chest X-ray (CXR)
KW - critical care
KW - intensive care
KW - mechanical ventilation
KW - mortality
KW - prognostication
KW - pulmonary oedema
UR - http://www.scopus.com/inward/record.url?scp=85148942551&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm12041252
DO - https://doi.org/10.3390/jcm12041252
M3 - Article
C2 - 36835791
SN - 2077-0383
VL - 12
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 4
M1 - 1252
ER -