Recent research from Vietnam indicates the challenges of predicting mortality among patients suffering from Acute Respiratory Distress Syndrome (ARDS), with key scoring systems showing limited effectiveness.
A retrospective observational study evaluated the prognostic accuracy of the Sequential Organ Failure Assessment (SOFA) score, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the ratios of peripheral oxygen saturation to fraction of inspired oxygen (SpO2/FiO2) and arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2). Conducted at Bach Mai Hospital in Hanoi, this extensive study spanned from August 2015 to August 2023 and included 335 adult ARDS patients.
Among the cohort, 66.9% were male, and the median age was 55 years; distressingly, 61.5% of patients succumbed during their hospital stay. The SOFA score and APACHE II scores exhibited poor discriminatory ability for hospital mortality, with area under the receiver operating characteristic curve (AUROC) values of 0.651 and 0.693, respectively. Notably, both the SpO2/FiO2 and PaO2/FiO2 ratios also demonstrated inadequate discriminatory power, each having AUROC values of only 0.595.
Despite these limitations, findings indicated associations with mortality—a SOFA score of ≥ 10 emerged as a significant predictor, with adjusted odds ratio of 3.398. The APACHE II score, with its increased severity as assessed by the adjusted odds ratio of 1.152, along with the SpO2/FiO2 and PaO2/FiO2 ratios which were closely linked to outcomes, underline the importance of continuous evaluation of adverse conditions impacting ARDS patient survival.
ARDS is characterized by acute respiratory failure, indicating poor predictions often lead to challenges during treatment. Models such as the SOFA score and APACHE II have been traditional tools for risk assessment; nevertheless, their poor accuracy points to the need for enhancement or development of new scoring systems, particularly for regions with resource constraints like Vietnam.
Within this study, researchers gathered retrospective data from patients diagnosed with ARDS based on the Berlin criteria, encompassing parameters associated with hospitalization. The primary determination was hospital mortality, defined as any cause of death during the stay, with secondary outcomes including complications experienced and lengths of hospital stays.
This study’s demographic insights highlighted prevalent conditions among patients, with pneumonia identified as the primary cause of ARDS, complicted by significant infection rates. Common complications included hospital-acquired pneumonia (HAP) affecting 61.8% of patients, alongside dangers such as septic shock and acute kidney injury, evidencing the multifaceted threats ARDS patients face.
Notably, the study reinforces findings from previously published research wherein high mortality rates, due to both physiological and systemic causes, remain consistent across similar patient populations. Variations such as delayed interventions from local hospitals to central ones significantly contributed to poor outcomes observed within the cohort.
While limitations persist—such as the focus on just one hospital and the exclusion of data from patients not referred from local clinics—researchers emphasized the necessity for future investigations aimed at refining these predictive measures. The results evoke calls for methodologies to standardize care and potentially improve ARDS management strategies within lower-middle-income countries like Vietnam.
The findings presented signal not only the demand for more accurate prediction tools to help guide clinical decisions but also highlight the underlying healthcare systemic issues facing medical establishments tasked with managing severe conditions such as ARDS. The study serves as both documentation of present challenges and as groundwork for future efforts directed recognizing the pressing need for innovative approaches to patient prognostication and care.