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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2014

01-03-2014 | Original

One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome

Authors: Chen Yu Wang, Carolyn S. Calfee, Devon W. Paul, David R. Janz, Addison K. May, Hanjing Zhuo, Gordon R. Bernard, Michael A. Matthay, Lorraine B. Ware, Kirsten Neudoerffer Kangelaris

Published in: Intensive Care Medicine | Issue 3/2014

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Abstract

Purpose

Advances in supportive care and ventilator management for acute respiratory distress syndrome (ARDS) have resulted in declines in short-term mortality, but risks of death after survival to hospital discharge have not been well described. Our objective was to quantify the difference between short-term and long-term mortality in ARDS and to identify risk factors for death and causes of death at 1 year among hospital survivors.

Methods

This multi-intensive care unit, prospective cohort included patients with ARDS enrolled between January 2006 and February 2010. We determined the clinical characteristics associated with in-hospital and 1-year mortality among hospital survivors and utilized death certificate data to identify causes of death.

Results

Of 646 patients hospitalized with ARDS, mortality at 1 year was substantially higher (41 %, 95 % CI 37–45 %) than in-hospital mortality (24 %, 95 % CI 21–27 %), P < 0.0001. Among 493 patients who survived to hospital discharge, the 110 (22 %) who died in the subsequent year were older (P < 0.001) and more likely to have been discharged to a nursing home, other hospital, or hospice compared to patients alive at 1 year (P < 0.001). Important predictors of death among hospital survivors were comorbidities present at the time of ARDS, and not living at home prior to admission. ARDS-related measures of severity of illness did not emerge as independent predictors of mortality in hospital survivors.

Conclusions

Despite improvements in short-term ARDS outcomes, 1-year mortality is high, mostly because of the large burden of comorbidities, which are prevalent in patients with ARDS.
Appendix
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Metadata
Title
One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome
Authors
Chen Yu Wang
Carolyn S. Calfee
Devon W. Paul
David R. Janz
Addison K. May
Hanjing Zhuo
Gordon R. Bernard
Michael A. Matthay
Lorraine B. Ware
Kirsten Neudoerffer Kangelaris
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 3/2014
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-013-3186-3

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