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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2014

Open Access 01-12-2014 | Research

Is there still a role for the lung injury score in the era of the Berlin definition ARDS?

Authors: Kirsten Neudoerffer Kangelaris, Carolyn S Calfee, Addison K May, Hanjing Zhuo, Michael A Matthay, Lorraine B Ware

Published in: Annals of Intensive Care | Issue 1/2014

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Abstract

Background

The Lung Injury Score (LIS) remains a commonly utilized measure of lung injury severity though the additive value of LIS to predict ARDS outcomes over the recent Berlin definition of ARDS, which incorporates severity, is not known.

Methods

We tested the association of LIS (in which scores range from 0 to 4, with higher scores indicating more severe lung injury) and its four components calculated on the day of ARDS diagnosis with ARDS morbidity and mortality in a large, multi-ICU cohort of patients with Berlin-defined ARDS. Receiver Operator Characteristic (ROC) curves were generated to compare the predictive validity of LIS for mortality to Berlin stages of severity (mild, moderate and severe).

Results

In 550 ARDS patients, a one-point increase in LIS was associated with 58% increased odds of in-hospital death (95% CI 14 to 219%, P = 0.006), a 7% reduction in ventilator-free days (95% CI 2 to 13%, P = 0.01), and, among patients surviving hospitalization, a 25% increase in days of mechanical ventilation (95% CI 9 to 43%, P = 0.001) and a 16% increase (95% CI 2 to 31%, P = 0.02) in the number of ICU days. However, the mean LIS was only 0.2 points higher (95% CI 0.1 to 0.3) among those who died compared to those who lived. Berlin stages of severity were highly correlated with LIS (Spearman’s rho 0.72, P < 0.0001) and were also significantly associated with ARDS mortality and similar morbidity measures. The predictive validity of LIS for mortality was similar to Berlin stages of severity with an area under the curve of 0.58 compared to 0.60, respectively (P-value 0.49).

Conclusions

In a large, multi-ICU cohort of patients with ARDS, both LIS and the Berlin definition severity stages were associated with increased in-hospital morbidity and mortality. However, predictive validity of both scores was marginal, and there was no additive value of LIS over Berlin. Although neither LIS nor the Berlin definition were designed to prognosticate outcomes, these findings suggest that the role of LIS in characterizing lung injury severity in the era of the Berlin definition ARDS may be limited.
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Metadata
Title
Is there still a role for the lung injury score in the era of the Berlin definition ARDS?
Authors
Kirsten Neudoerffer Kangelaris
Carolyn S Calfee
Addison K May
Hanjing Zhuo
Michael A Matthay
Lorraine B Ware
Publication date
01-12-2014
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2014
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/2110-5820-4-4

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