Date Published: October 25, 2017
Publisher: John Wiley and Sons Inc.
Author(s): Yoshiaki Kinoshita, Hiroshi Ishii, Hisako Kushima, Kentaro Watanabe, Masaki Fujita.
Acute respiratory distress syndrome (ARDS) is a life‐threatening lung disease that usually occurs in patients with the underling risk factors that triggers lung inflammation. We sometimes encounter patients with ARDS lacking common risk factors. Recent studies have indicated the effectiveness of corticosteroids for this cohort. However, the characteristics of survivors with ARDS who lack common risk factors, and who received high‐dose methylprednisolone pulse therapy (MPPT), are not known.
We undertook a retrospective study of patients with ARDS lacking common risk factors, who received i.v. MPPT for 3 days. The patients (n = 46) were classified into two groups, survivors (n = 23) and non‐survivors (n = 23), based on their survival at 60 days after the initiation of MPPT, and their clinical and radiological parameters were evaluated.
The patient characteristics and disease severity of the two groups were comparable. The percentage of consolidation/(ground‐glass attenuation [GGA] + consolidation) on the chest computed tomography scans of survivors was significantly lower than that of non‐survivors (survivors, 5.63% [2.31–13.8] versus non‐survivors, 27.2% [5.97–41.4]; P = 0.01). In the stratified analysis, the percentage of consolidation/(GGA + consolidation) was significantly associated with 60‐day survival.
Our results show that the percentage of consolidation/(GGA + consolidation) on the chest CT scans is an independent prognostic factor for patients with ARDS lacking common risk factors after MPPT.
The acute respiratory distress syndrome (ARDS) is a life‐threatening inflammatory lung disease with a mortality rate of 40–50%.1, 2 Acute respiratory distress syndrome is defined as acute onset of hypoxemia and bilateral pulmonary infiltrates not attributed to cardiac failure or fluid overload with pulmonary or non‐pulmonary risk factors that trigger lung inflammation.1, 2 Diffuse alveolar damage (DAD), which is usually resistant to treatment, is the accepted histological hallmark of ARDS.1, 2
Pure ARDS/DAD is usually resistant to treatment, but ARDS lacking common risk factors sometimes shows responsiveness to corticosteroid treatment.4, 5, 6, 8, 19, 20 Although the histological diagnosis of acute pulmonary injury is therefore quite important,8 invasive procedures cannot be applied in all patients with acute respiratory failure. Actually, we could only perform antemortem pathological examinations in 8/46 (17.4%) patients. We found that the low percentage of consolidation/(GGA + consolidation) on the chest CT scans was associated with a significant increase in 60‐day survival in patients with ARDS lacking common risk factors after high‐dose steroid therapy.
To the best of the authors’ knowledge, this is the first study to evaluate the prognostic factors in patients with ARDS lacking common risk factors after high‐dose steroid therapy. The percentage of the extent of consolidation/(GGA + consolidation) was significantly associated with 60‐day survival of this population.
Approval of the research protocol: The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki. Committee of the Fukuoka University Hospital Institutional Review Board, Approval No. 16‐1‐15. Ethics Committee of the institution waived the requirement for informed consent.