Clinical phenotypes from fatal cases of acute respiratory distress syndrome caused by pneumonia

Ichikado, Kazuya; Kawamura, Kodai; Johkoh, Takeshi; Fujimoto, Kiminori; Shintani, Ayumi; Hashimoto, Satoru; Eguchi, Yoshitomo; Yasuda, Yuko; Anan, Keisuke; Shingu, Naoki; Sakata, Yoshihiko; Hisanaga, Junpei; Nitawaki, Tatsuya; Iio, Miwa; Sekido, Yuko; Nishiyama, Kenta; Nakamura, Kazunori; Suga, Moritaka; Ichiyasu, Hidenori; Sakagami, Takuro

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.