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The Prognostic Capacity of the Radiographic Assessment for Lung Edema Score in Patients With COVID-19 Acute Respiratory Distress Syndrome-An International Multicenter Observational Study.
Valk, Christel M A; Zimatore, Claudio; Mazzinari, Guido; Pierrakos, Charalampos; Sivakorn, Chaisith; Dechsanga, Jutamas; Grasso, Salvatore; Beenen, Ludo; Bos, Lieuwe D J; Paulus, Frederique; Schultz, Marcus J; Pisani, Luigi.
  • Valk CMA; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.
  • Zimatore C; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.
  • Mazzinari G; Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
  • Pierrakos C; Department of Anaesthesiology and Critical Care, Hospital Universitario y Politecnico la Fe, Valencia, Spain.
  • Sivakorn C; Perioperative Medicine Research Group, Instituto de Investigación Sanitaria la Fe, Valencia, Spain.
  • Dechsanga J; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.
  • Grasso S; Department of Intensive Care, Centre Hospitalier Universitaire Brussels, Brussels, Belgium.
  • Beenen L; Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Bos LDJ; Division of Pulmonary and Critical Care, Department of Medicine, Chonburi Hospital, Chonburi, Thailand.
  • Paulus F; Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy.
  • Schultz MJ; Department of Radiology, Amsterdam UMC, Amsterdam, Netherlands.
  • Pisani L; Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands.
Front Med (Lausanne) ; 8: 772056, 2021.
Article in English | MEDLINE | ID: covidwho-1650404
ABSTRACT

Background:

The radiographic assessment for lung edema (RALE) score has an association with mortality in patients with acute respiratory distress syndrome (ARDS). It is uncertain whether the RALE scores at the start of invasive ventilation or changes thereof in the next days have prognostic capacities in patients with COVID-19 ARDS. Aims and

Objectives:

To determine the prognostic capacity of the RALE score for mortality and duration of invasive ventilation in patients with COVID-19 ARDS.

Methods:

An international multicenter observational study included consecutive patients from 6 ICUs. Trained observers scored the first available chest X-ray (CXR) obtained within 48 h after the start of invasive ventilation ("baseline CXR") and each CXRs thereafter up to day 14 ("follow-up CXR"). The primary endpoint was mortality at day 90. The secondary endpoint was the number of days free from the ventilator and alive at day 28 (VFD-28).

Results:

A total of 350 CXRs were scored in 139 patients with COVID-19 ARDS. The RALE score of the baseline CXR was high and was not different between survivors and non-survivors (33 [24-38] vs. 30 [25-38], P = 0.602). The RALE score of the baseline CXR had no association with mortality (hazard ratio [HR], 1.24 [95% CI 0.88-1.76]; P = 0.222; area under the receiver operating characteristic curve (AUROC) 0.50 [0.40-0.60]). A change in the RALE score over the first 14 days of invasive ventilation, however, had an independent association with mortality (HR, 1.03 [95% CI 1.01-1.05]; P < 0.001). When the event of death was considered, there was no significant association between the RALE score of the baseline CXR and the probability of being liberated from the ventilator (HR 1.02 [95% CI 0.99-1.04]; P = 0.08).

Conclusion:

In this cohort of patients with COVID-19 ARDS, with high RALE scores of the baseline CXR, the RALE score of the baseline CXR had no prognostic capacity, but an increase in the RALE score in the next days had an association with higher mortality.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.772056

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Front Med (Lausanne) Year: 2021 Document Type: Article Affiliation country: Fmed.2021.772056