背景:肺水肿的影像学评估(RALE)评分与急性呼吸窘迫综合征(ARDS)患者的死亡率有关。目前尚不确定有创通气开始时的RALE评分或随后几天的变化是否具有COVID-19ARDS患者的预后能力。目的和目标:确定RALE评分对COVID-19ARDS患者的死亡率和有创通气持续时间的预后能力。方法:一项国际多中心观察性研究包括来自6个ICU的连续患者。经过培训的观察者在开始有创通气后48小时内(“基线CXR”)和此后直到第14天(“随访CXR”)的每个CXR进行评分。主要终点是第90天的死亡率。次要终点是在第28天(VFD-28)时离开呼吸机并存活的天数。结果:139例COVID-19ARDS患者共分为350例CXRs。基线CXR的RALE评分较高,幸存者和非幸存者之间没有差异(33[24-38]vs.30[25-38],P=0.602)。基线CXR的RALE评分与死亡率无关(风险比[HR],1.24[95%CI0.88-1.76];P=0.222;接受者工作特征曲线下面积(AUROC)0.50[0.40-0.60])。有创通气前14天RALE评分的变化,然而,与死亡率有独立的关联(HR,1.03[95%CI1.01-1.05];P<0.001)。当考虑死亡事件时,基线CXR的RALE评分与呼吸机释放概率之间无显著相关性(HR1.02[95%CI0.99-1.04];P=0.08).结论:在COVID-19ARDS患者队列中,基线CXR的RALE评分较高,基线CXR的RALE评分没有预后能力,但随后几天RALE评分的增加与较高的死亡率相关.
Background: The radiographic assessment for lung edema (RALE) score has an association with mortality in patients with acute respiratory distress syndrome (ARDS). It is uncertain whether the RALE scores at the start of invasive ventilation or changes thereof in the next days have prognostic capacities in patients with COVID-19 ARDS. Aims and Objectives: To determine the prognostic capacity of the RALE score for mortality and duration of invasive ventilation in patients with COVID-19 ARDS. Methods: An international multicenter observational study included consecutive patients from 6 ICUs. Trained observers scored the first available chest X-ray (CXR) obtained within 48 h after the start of invasive ventilation (\"baseline CXR\") and each CXRs thereafter up to day 14 (\"follow-up CXR\"). The primary endpoint was mortality at day 90. The secondary endpoint was the number of days free from the ventilator and alive at day 28 (VFD-28). Results: A total of 350 CXRs were scored in 139 patients with COVID-19 ARDS. The RALE score of the baseline CXR was high and was not different between survivors and non-survivors (33 [24-38] vs. 30 [25-38], P = 0.602). The RALE score of the baseline CXR had no association with mortality (hazard ratio [HR], 1.24 [95% CI 0.88-1.76]; P = 0.222; area under the receiver operating characteristic curve (AUROC) 0.50 [0.40-0.60]). A change in the RALE score over the first 14 days of invasive ventilation, however, had an independent association with mortality (HR, 1.03 [95% CI 1.01-1.05]; P < 0.001). When the event of death was considered, there was no significant association between the RALE score of the baseline CXR and the probability of being liberated from the ventilator (HR 1.02 [95% CI 0.99-1.04]; P = 0.08). Conclusion: In this cohort of patients with COVID-19 ARDS, with high RALE scores of the baseline CXR, the RALE score of the baseline CXR had no prognostic capacity, but an increase in the RALE score in the next days had an association with higher mortality.