Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS
Matthieu Jabaudon, Jules Audard, Bruno Pereira, Samir Jaber, Jean‐Yves Lefrant, Raïko Blondonnet, Thomas Godet, Emmanuel Futier, Céline Lambert, Jean-Étienne Bazin, Julie A. Bastarache, Jean‐Michel Constantin, Lorraine B. Ware, Bertrand Souweine, Nathanael Eisenmann, Jean-Pierre Quenot, Philippe Seguin, Karim Asehnoune, Sigismond Lasocki, Martine Ferrandiere, Achile Sossou, Olivier Langeron, Marc Leone, Herve Dupont, Benoit Veber, Carole Ichai, Thomas Rimmelé, François Legay, Fabien Grelon, Claire Dahyot-Fizelier, Sophie Cayot, Thomas Godet, Renaud Guerin, Camille Verlhac, Russell Chabanne, Bernard Cosserant, Raiko Blondonnet, Alexandre Lautrette, Laurent Muller, Pablo Massanet, Caroline Boutin, Saber Barbar, Claire Roger, Fouad Belafia, Moussa Cisse, Marion Monnin, Matthieu Conseil, Julie Carr, Audrey De Jong, Gérald Chanques, Auguste Dargent, Thomas Crozon, Julien Clauzel, Marinne Le Core, Pascal Andreu, Thomas Lebouvrier, Yoann Launey, Antoine Roquilly, Raphael Cinotti, Anne-Charlotte Tellier, Mathilde Barbaz, Benjamin Cohen, Edouard Lemarche, Pierre-Marie Bertrand, Charlotte Arbelot, Laurent Zieleskiewicz, Emmanuelle Hammad, Garry Duclos, Mathieu Calypso, Jean-Christophe Orban, Hervé Quintard, Mona Assefi, Jerome Morel, Serge Molliex, Frank Petitas, Hadanou Nanadougmar
Abstract
BACKGROUND: The Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time. RESEARCH QUESTION: Are early changes in RALE score over time associated with survival in patients with ARDS? STUDY DESIGN AND METHODS: Data from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model. RESULTS: RALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry. INTERPRETATION: The change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.