Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study

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dc.contributor.authorLorente, José A.
dc.contributor.authorCardinal-Fernández, Pablo
dc.contributor.authorMuñoz, Diego
dc.contributor.authorFrutos-Vivar, Fernando
dc.contributor.authorThille, Arnaud W.
dc.contributor.authorJaramillo, Carlos
dc.contributor.authorBallén-Barragán, Aida
dc.contributor.authorRodríguez, José M.
dc.contributor.authorPeñuelas, Oscar
dc.contributor.authorOrtiz, Guillermo
dc.contributor.authorBlanco, José
dc.contributor.authorValle Pinheiro, Bruno
dc.contributor.authorNin, Nicolás
dc.contributor.authorMarin, María del Carmen
dc.contributor.authorEsteban, Andrés
dc.contributor.authorThompson, Taylor B.
dc.date.accessioned2020-08-06T18:19:40Z
dc.date.available2020-08-06T18:19:40Z
dc.date.issued2015
dc.description.abstractenglishObjective To demonstrate that among patients with acute respiratory distress syndrome (ARDS), the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a specific subphenotype. Methods We studied 149 patients who died in our ICU with the clinical diagnosis of ARDS according to the Berlin Definition (BD) and who had autopsy examination. We compared the change over time of different clinical variables in patients with (n = 49) and without (n = 100) DAD. A predictive model for the presence of DAD was developed and validated in an independent cohort of 57 patients with ARDS and postmortem examination (21 of them with DAD). Results Patients with DAD, as compared to patients without DAD, had a lower PaO2/FiO2 ratio and dynamic respiratory system compliance, and a higher SOFA score and INR, and were more likely to die of hypoxemia and less likely to die of shock. In multivariate analysis, variables associated with DAD [odds ratio, 95 % confidence interval (CI)] were PaO2/FiO2 ratio [0.988 (0.981–0.995)], dynamic respiratory system compliance [0.937 (0.892–0.984)] and age [0.972 (0.946–0.999)]. Areas under the ROC curve (95 % CI) for the classification of DAD using the regression model or the BD were, respectively, 0.74 (0.65–0.82) and 0.64 (0.55–0.72) (p = 0.03). In the validation cohort, the areas under the ROC curve for the diagnosis of DAD were 0.73 (0.56–0.90) and 0.67 (0.54–0.81) for the regression model and the BD, respectively. Conclusions The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org//10.1007/s00134-015-4046-0
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.issn1432-1238
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlhttps://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/3711
dc.language.isoeng
dc.publisherSpringerLinkspa
dc.publisher.journalIntensive Care Medicinespa
dc.relation.ispartofseriesIntensive Care Medicine, 1432-1238, Vol. 41, 2015, p. 1921–1930spa
dc.relation.urihttps://link.springer.com/article/10.1007/s00134-015-4046-0
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf2
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightsAcceso abierto
dc.rights.creativecommons2015-09-18
dc.rights.localAcceso abiertospa
dc.subject.keywordsAdult respiratory distress syndromespa
dc.subject.keywordsDiffuse alveolar damagespa
dc.subject.keywordsSubphenotypespa
dc.subject.keywordsHistologyspa
dc.subject.keywordsAutopsyspa
dc.subject.keywordsHyaline membranesspa
dc.titleAcute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy studyspa
dc.title.translatedAcute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy studyspa
dc.type.coarhttps://purl.org/coar/resource_type/c_6501
dc.type.driverinfo:eu-repo/semantics/article
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localArtículo de revista

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