Journal of the Formosan Medical Association
Volume 108, Issue 9 , Pages 694-703, September 2009

Timing of Acute Respiratory Distress Syndrome Onset is Related to Patient Outcome

  • Kuang-Ming Liao

      Affiliations

    • Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, Tainan, Taiwan
    • Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    • ,
  • Chang-Wen Chen

      Affiliations

    • Medical Intensive Care Unit, Tainan, Taiwan
    • ,
  • Tzuen-Ren Hsiue

      Affiliations

    • Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
    • ,
  • Wei-Chieh Lin

      Affiliations

    • Medical Intensive Care Unit, Tainan, Taiwan
    • Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Wei-Chieh Lin, Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 704, Taiwan

Received 21 May 2008; received in revised form 9 January 2009; accepted 19 March 2009.

Article Outline

Background/Purpose

Acute respiratory distress syndrome (ARDS) is a major cause of mortality and morbidity in adult intensive care units. The relationship between the timing of ARDS onset and outcome is not well known. The objective of this study was to investigate the outcome of patients with late-onset ARDS during hospitalization.

Methods

We prospectively enrolled patients who were intubated and fulfilled ARDS criteria in medical and surgical intensive care units in a tertiary referral medical center from December 1, 2004 to May 31, 2006. Those who developed ARDS more than 48 hours after hospital admission were categorized as late- onset ARDS; otherwise, they were defined as early-onset ARDS. We assessed the risk factors for hospital mortality using multivariate analysis and 90-day survival using Kaplan–Meier analysis between early- and late-onset ARDS, and between direct and indirect ARDS.

Results

A total of 172 patients were included in the study. Overall mortality rate was 70%. Late-onset ARDS [odds ratio (OR): 3.06; 95% confidence interval (CI): 1.41 to 6.63; p = 0.005] and initial shock (OR: 8.20; 95% CI: 3.39–19.79; p < 0.001) were the independent risk factors for hospital mortality. Patients with late-onset ARDS had higher hospital mortality rate (83% vs. 60%; p = 0.002), longer duration of mechanical ventilation (27.0 ± 23.4 vs.14.6 ± 11.5 days; p < 0.001) and length of intensive care unit stay (25.5 ± 20.6 vs. 15.6 ± 13.6 days; p < 0.001) than patients with early-onset ARDS. The 90-day survival showed that both early-onset ARDS and direct ARDS were associated with better survival.

Conclusion

Patients with late-onset ARDS are associated with poor prognosis and should be managed as high-risk patients.

Key Words:  adult , intensive care units , mortality , respiratory distress syndrome , treatment outcome

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PII: S0929-6646(09)60392-2

doi:10.1016/S0929-6646(09)60392-2

Journal of the Formosan Medical Association
Volume 108, Issue 9 , Pages 694-703, September 2009

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