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Attributable mortality of acute respiratory distress syndrome: a systematic review, meta-analysis and survival analysis using targeted minimum loss-based estimation

Attributable mortality of acute respiratory distress syndrome: a systematic review, meta-analysis and survival analysis using targeted minimum loss-based estimation

Authors :
Torres, Lisa K
Hoffman, Katherine L
Oromendia, Clara
Diaz, Ivan
Harrington, John S
Schenck, Edward J
Price, David R
Gomez-Escobar, Luis
Higuera, Angelica
Vera, Mayra Pinilla
Baron, Rebecca M
Fredenburgh, Laura E
Huh, Jin-Won
Choi, Augustine M K
Siempos, Ilias I
Source :
Thorax; 2021, Vol. 76 Issue: 12 p1176-1185, 10p
Publication Year :
2021

Abstract

BackgroundAlthough acute respiratory distress syndrome (ARDS) is associated with high mortality, its direct causal link with death is unclear. Clarifying this link is important to justify costly research on prevention of ARDS.ObjectiveTo estimate the attributable mortality, if any, of ARDS.DesignFirst, we performed a systematic review and meta-analysis of observational studies reporting mortality of critically ill patients with and without ARDS matched for underlying risk factor. Next, we conducted a survival analysis of prospectively collected patient-level data from subjects enrolled in three intensive care unit (ICU) cohorts to estimate the attributable mortality of critically ill septic patients with and without ARDS using a novel causal inference method.ResultsIn the meta-analysis, 44 studies (47 cohorts) involving 56 081 critically ill patients were included. Mortality was higher in patients with versus without ARDS (risk ratio 2.48, 95% CI 1.86 to 3.30; p<0.001) with a numerically stronger association between ARDS and mortality in trauma than sepsis. In the survival analysis of three ICU cohorts enrolling 1203 critically ill patients, 658 septic patients were included. After controlling for confounders, ARDS was found to increase the mortality rate by 15% (95% CI 3% to 26%; p=0.015). Significant increases in mortality were seen for severe (23%, 95% CI 3% to 44%; p=0.028) and moderate (16%, 95% CI 2% to 31%; p=0.031), but not for mild ARDS.ConclusionsARDS has a direct causal link with mortality. Our findings provide information about the extent to which continued funding of ARDS prevention trials has potential to impart survival benefit.PROSPERO Registration NumberCRD42017078313

Details

Language :
English
ISSN :
00406376 and 14683296
Volume :
76
Issue :
12
Database :
Supplemental Index
Journal :
Thorax
Publication Type :
Periodical
Accession number :
ejs58268969
Full Text :
https://doi.org/10.1136/thoraxjnl-2020-215950