Development and Validation of an Acute Respiratory Distress Syndrome Prediction Model in Coronavirus Disease-2019: Updated Lung Injury Prediction Score

Objective

To develop and validate an updated lung injury prediction score (c-LIPS) tailored for predicting acute respiratory distress syndrome (ARDS) in coronavirus disease-2019.

Patients and Methods

This was a registry-based cohort study using the Viral Infection and Respiratory Illness Universal Study. Hospitalized adult patients between January 2020 and January 2022 were screened. Patients who qualified for ARDS within the first day of admission were excluded. Development cohort consisted of patients enrolled from participating Mayo Clinic sites. The validation analyses were carried out on remaining patients enrolled from more than 120 hospitals in 15 countries. The original LIPS was calculated and enhanced using reported COVID-19 specific laboratory risk factors, constituting c-LIPS. The main outcome was ARDS development and secondary outcomes included hospital mortality, invasive mechanical ventilation, progression in World Health Organization ordinal scale.

Results

The derivation cohort consisted of 3710 patients, of whom 28% developed ARDS. The c-LIPS discriminated COVID-19 patients who developed ARDS with an AUC of 0.79 compared to original LIPS (AUC 0.74, P<.001) with good calibration accuracy (Hosmer-Lemeshow P=.50). Despite different characteristics of the two cohorts, the c-LIPS’s performance was comparable in the validation cohort of 5426 patients (16% ARDS), with an AUC of 0.74; and its discriminatory performance was significantly higher than the LIPS (AUC 0.68, P<.001). The c-LIPS’s performance in predicting the requirement for invasive mechanical ventilation in derivation and validation cohorts had an AUC of 0.74 and 0.72, respectively.

Conclusion

In this large patient sample c-LIPS was successfully tailored to predict ARDS in COVID-19 patients.

Effectiveness of noninvasive positive pressure ventilation in the treatment of acute respiratory failure in severe acute respiratory syndrome

OBJECTIVES

To study the effectiveness of noninvasive positive pressure ventilation (NIPPV) in the treatment of acute respiratory failure (ARF) in severe acute respiratory syndrome (SARS), and the associated infection risk.

METHODS

All patients with the diagnosis of probable SARS admitted to a regional hospital in Hong Kong from March 9 to April 28, 2003, and who had SARS-related respiratory distress complications were recruited for NIPPV usage. The health status of all health-care workers working in the NIPPV wards was closely monitored, and consent was obtained to check serum for coronavirus serology. Patient outcomes and the risk of SARS transmission to health-care workers were assessed.

RESULTS

NIPPV was applied to 20 patients (11 male patients) with ARF secondary to SARS. Mean age was 51.4 years, and mean acute physiology and chronic health evaluation II score was 5.35. Coronavirus serology was positive in 95% (19 of 20 patients). NIPPV was started 9.6 days (mean) from symptom onset, and mean duration of NIPPV usage was 84.3 h. Endotracheal intubation was avoided in 14 patients (70%), in whom the length of ICU stay was shorter (3.1 days vs 21.3 days, p < 0.001) and the chest radiography score within 24 h of NIPPV was lower (15.1 vs 22.5, p = 0.005) compared to intubated patients. Intubation avoidance was predicted by a marked reduction in respiratory rate (9.2 breaths/min) and supplemental oxygen requirement (3.1 L/min) within 24 h of NIPPV. Complications were few and reversible. There were no infections among the 105 health-care workers caring for the patients receiving NIPPV.

CONCLUSIONS

NIPPV was effective in the treatment of ARF in the patients with SARS studied, and its use was safe for health-care workers.