Background: Acute respiratory distress syndrome (ARDS) is a common diagnosis in intensive care units (ICUs) and is frequently correlated with acute kidney injury (AKI). Objectives: To investigate the outcomes of critically ill patients with ARDS and to shed light on the association between prognosis and risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal failure (RIFLE) classification. Methods: This retrospective study investigated the medical records of 60 critically ill patients with ARDS who underwent open lung biopsy (OLB) in 2 medical intensive care units of a tertiary care hospital from December 1999 to May 2005. Results: The overall mortality rate was 55% (33/60). The increase in mortality was progressive and significant (χ2 for trend, p < 0.001) with increasing severity of the RIFLE classification. The Glasgow coma scale, alveolar-arterial O2 tension difference and maximum RIFLE (RIFLEmax) score for days 1 and 3 in the ICU and on the day of OLB were independent predictors of hospital mortality by forward conditional logistic regression. Hosmer-Lemeshow goodness-of-fit test results demonstrate that RIFLEmax has a good fit. The area under the receiver operating characteristic curve (AUROC) and RIFLEmax score indicate good discriminative power (AUROC 0.750 ± 0.063, p = 0.001). Cumulative survival rates at the 6-month follow-up following hospital discharge differed significantly (p < 0.05) for non-AKI versus RIFLEmax-risk, RIFLEmax-injury and RIFLEmax-failure patients. Conclusion: In patients with ARDS undergoing OLB, the use of the RIFLE score improves prediction of outcome.

Keywords:
Acute respiratory distress syndrome, Kidney injury, Outcome prediction
1.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R: Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 1994;20:225–232.
2.
Abel SJ, Finney SJ, Brett SJ, Keogh BF, Morgan CJ, Evans TW: Reduced mortality in association with the acute respiratory distress syndrome (ARDS). Thorax 1998;53:292–294.
3.
Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP: Causes and timing of death in patients with ARDS.Chest 2005;128:525–532.
4.
Kellum JA, Levin N, Bouman C, Lameire N: Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002;8:509–514.
5.
Schrier RW, Wang W, Poole B, Mitra A: Acute renal failure: definitions, diagnosis, pathogenesis, and therapy.J Clin Invest2004;114:5–14.
6.
Lameire N, Van Biesen W, Vanholder R: Acute renal failure. Lancet 2005;365:417–430.
7.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Quality Initiative workgroup: Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group.Crit Care 2004;8:R204–R212.
8.
Ricci Z, Cruz D, Ronco C: The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int 2008;73:538–546.
9.
Bellomo R, Kellum JA, Ronco C: Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 2007;33:409–413.
10.
Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C: An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006;34:1913–1917.
11.
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006;10:R73.
12.
Kao KC, Tsai YH, Wu YK, Chen NH, Hsieh MJ, Huang SF, Huang CC: Open lung biopsy in early-stage acute respiratory distress syndrome. Crit Care 2006;10:R106.
13.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–824.
14.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710.
15.
Murray JF, Matthay MA, Luce JM, Flick MR: An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1988;134:720–723.
16.
Tsai MH, Chen YC, Ho YP, Fang JT, Lien JM, Chiu CT, Liu NJ, Chen PC: Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients. J Clin Gastroenterol 2003;37:251–257.
17.
Lin CY, Chen YC, Tsai FC, Tian YC, Jenq CC, Fang JT, Yang CW: RIFLE classification is predictive of short-term prognosis in critically ill patients with acute renal failure supported by extracorporeal membrane oxygenation. Nephrol Dial Transplant 2006;21:2867–2873.
18.
Jenq CC, Tsai MH, Tian YC, Lin CY, Yang C, Liu NJ, Lien JM, Chen YC, Fang JT, Chen PC, Yang CW: RIFLE classification can predict short-term prognosis in critically ill cirrhotic patients. Intensive Care Med 2007;33:1921–1930.
19.
Papazian L, Doddoli C, Chetaille B, Gernez Y, Thirion X, Roch A, Donati Y, Bonnety M, Zandotti C, Thomas P: A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 2007;35:755–762.
20.
Lim SY, Suh GY, Choi JC, Koh WJ, Lim SY, Han J, Lee KS, Shim YM, Chung MP, Kim H, Kwon OJ: Usefulness of open lung biopsy in mechanically ventilated patients with undiagnosed diffuse pulmonary infiltrates: influence of comorbidities and organ dysfunction. Crit Care 2007;11:R93.
21.
Arabi Y, Ahmed R, Ahmed Q, Rahman MU, Yamani N: Risks and benefits of open-lung biopsy in the mechanically ventilated critically ill population: a cohort study and literature review. Med Sci Monit 2007;13:CR365–CR371.
22.
Kuiper JW, Groeneveld AB, Slutsky AS, Plötz FB: Mechanical ventilation and acute renal failure. Crit Care Med 2005;33:1408–1415.
23.
Parra ER, Kairalla RA, Ribeiro de Carvalho CR, Eher E, Capelozzi V: Inflammatory cell phenotyping of the pulmonary interstitium in idiopathic interstitial pneumonia. Respiration 2007;74:159–169.
24.
Krafft P, Fridrich P, Pernerstorfer T, Fitzgerald RD, Koc D, Schneider B, Hammerle AF, Steltzer H: The acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations. Intensive Care Med 1996;22:519–529.
25.
Pavone LA, Dirocco JD, Carney DE, Gatto LA, McBride NT, Norton JA, Hession RM, Boubert F, Hojnowski KA, Lafollette RL, Dries DJ, Nieman GF: Absence of alveolar tears in rat lungs with significant alveolar instability. Respiration 2007;74:439–446.
26.
Sloane PJ, Gee MH, Gottlieb JE, Albertine KH, Peters SP, Burns JR, Machiedo G, Fish JE: A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis 1992;146:419–426.
27.
Kim DJ, Park SH, Sheen MR, Jeon US, Kim SW, Koh ES, Woo SK: Comparison of experimental lung injury from acute renal failure with injury due to sepsis. Respiration 2006;73:815–824.
28.
Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ; Mechanical Ventilation International Study Group: Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002;287:345–355.
29.
Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA: Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med 1995;152:1818–1824.
30.
Bone RC, Balk R, Slotman G, Maunder R, Silverman H, Hyers TM, Kerstein MD: Adult respiratory distress syndrome. Sequence and importance of development of multiple organ failure. Chest 1992;101:320–326.
31.
Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR: Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 2002;136:25–36.
32.
Hsu CW, Lee DL, Lin SL, Sun SF, Chang HW: The initial response to inhaled nitric oxide treatment for intensive care unit patients with acute respiratory distress syndrome. Respiration 2008;75:288–295.
33.
Lu Y, Song Z, Zhou X, Huang S, Zhu D, Yang C Bai X, Sun B, Spragg R; Shanghai ARDS Study Group: A 12-month clinical survey of incidence and outcome of acute respiratory distress syndrome in Shanghai intensive care units. Intensive Care Med 2004;30:2197–2203.
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2008
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