%0 Journal Article
%T Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS.
%A Jabaudon M
%A Audard J
%A Pereira B
%A Jaber S
%A Lefrant JY
%A Blondonnet R
%A Godet T
%A Futier E
%A Lambert C
%A Bazin JE
%A Bastarache JA
%A Constantin JM
%A Ware LB
%A  
%J Chest
%V 158
%N 6
%D 12 2020
%M 32659235
%F 10.262
%R 10.1016/j.chest.2020.06.070
%X 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.<BR>Are early changes in RALE score over time associated with survival in patients with ARDS?<BR>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.<BR>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.<BR>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.