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- Title
External validation of a biomarker and clinical prediction model for hospital mortality in acute respiratory distress syndrome.
- Authors
Zhao, Zhiguo; Wickersham, Nancy; Kangelaris, Kirsten; May, Addison; Bernard, Gordon; Matthay, Michael; Calfee, Carolyn; Koyama, Tatsuki; Ware, Lorraine; Kangelaris, Kirsten N; May, Addison K; Bernard, Gordon R; Matthay, Michael A; Calfee, Carolyn S; Ware, Lorraine B
- Abstract
<bold>Purpose: </bold>Mortality prediction in ARDS is important for prognostication and risk stratification. However, no prediction models have been independently validated. A combination of two biomarkers with age and APACHE III was superior in predicting mortality in the NHLBI ARDSNet ALVEOLI trial. We validated this prediction tool in two clinical trials and an observational cohort.<bold>Methods: </bold>The validation cohorts included 849 patients from the NHLBI ARDSNet Fluid and Catheter Treatment Trial (FACTT), 144 patients from a clinical trial of sivelestat for ARDS (STRIVE), and 545 ARDS patients from the VALID observational cohort study. To evaluate the performance of the prediction model, the area under the receiver operating characteristic curve (AUC), model discrimination, and calibration were assessed, and recalibration methods were applied.<bold>Results: </bold>The biomarker/clinical prediction model performed well in all cohorts. Performance was better in the clinical trials with an AUC of 0.74 (95% CI 0.70-0.79) in FACTT, compared to 0.72 (95% CI 0.67-0.77) in VALID, a more heterogeneous observational cohort. The AUC was 0.73 (95% CI 0.70-0.76) when FACTT and VALID were combined.<bold>Conclusion: </bold>We validated a mortality prediction model for ARDS that includes age, APACHE III, surfactant protein D, and interleukin-8 in a variety of clinical settings. Although the model performance as measured by AUC was lower than in the original model derivation cohort, the biomarker/clinical model still performed well and may be useful for risk assessment for clinical trial enrollment, an issue of increasing importance as ARDS mortality declines, and better methods are needed for selection of the most severely ill patients for inclusion.
- Subjects
ADULT respiratory distress syndrome; CLINICAL trials monitoring; PREDICTION models; COHORT analysis; PROGNOSIS; DISEASE risk factors; APACHE (Disease classification system); ARTIFICIAL respiration; COMPARATIVE studies; INTERLEUKINS; LONGITUDINAL method; LUNG injuries; RESEARCH methodology; MEDICAL cooperation; PULMONARY surfactant; RESEARCH; RESEARCH evaluation; EVALUATION research; RECEIVER operating characteristic curves; ACUTE diseases; HOSPITAL mortality
- Publication
Intensive Care Medicine, 2017, Vol 43, Issue 8, p1123
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-017-4854-5