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Original Research: CRITICAL CARE MEDICINE |

ARDS of Early or Late Onset: Does It Make a Difference?

Jean-Louis Vincent, MD, PhD, FCCP; Yasser Sakr, MB, BCh, PhD; Johan Groeneveld, MD; Durk F. Zandstra, MD; Eric Hoste, MD; Yannick Malledant, MD; Katie Lei, MD; Charles L. Sprung, MD, FCCP
Author and Funding Information

From the Department of Intensive Care (Dr Vincent), Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care (Dr Sakr), Friedrich-Schiller-University Jena, Germany; Department of Intensive Care (Dr Groeneveld), Vrije Universiteit Medical Center, Amsterdam, The Netherlands; Department of Intensive Care (Dr Zandstra), Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Intensive Care (Dr Hoste), Universitair Ziekenhuis Ghent, Belgium; Service de Réanimation (Dr Malledant), Centre Hospitalier Universitaire Pontchaillou of Rennes, France; Department of Critical Care (Dr Lei), St Thomas Hospital of London, United Kingdom; and Department of Anesthesiology and Critical Care Medicine (Dr Sprung), Hadassah Hebrew University Medical Center, Jerusalem, Israel.

Correspondence to: Jean-Louis Vincent, MD, PhD, FCCP, Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium; e-mail jlvincen@ulb.ac.be

A complete list of study participants is listed in the Appendix.


Funding/Support: The SOAP study was supported by an unlimited grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline, and NovoNordisk.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):81-87. doi:10.1378/chest.09-0714
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Background:  Differences in outcomes have been demonstrated for critically ill patients with late-onset compared with early-onset renal failure and late-onset compared with early-onset shock, which could cause a lead-time bias in clinical trials assessing potential therapies for these conditions. We used data from a large, multicenter observational study to assess whether late-onset ARDS was similarly associated with worse outcomes compared with early-onset ARDS.

Methods:  Data were extracted from the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, which involved 198 ICUs from 24 European countries. All adult patients admitted to a participating ICU between May 1, 2002 and May 15, 2002, were eligible, except those admitted for uncomplicated postoperative surveillance. Early/late onset acute lung injury (ALI)/ARDS was defined as ALI/ARDS occurring within/after 48 h of ICU admission.

Results:  Of the 3,147 patients included in the SOAP study, 393 (12.5%) had a diagnosis of ALI/ARDS; 254 had early-onset ALI/ARDS (64.6%), and 139 (35.5%) late-onset. Patients with early-onset ALI/ARDS had higher Simplified Acute Physiology II scores on admission and higher initial Sequential Organ Failure Assessment scores. Patients with late-onset ALI/ARDS had longer ICU and hospital lengths of stay than patients with early-onset ALI/ARDS. ICU and hospital mortality rates were, if anything, lower in late-onset ALI/ARDS than in early-onset ALI/ARDS, but these differences were not statistically significant.

Conclusions:  There were no significant differences in mortality rates between early- and late-onset ARDS, but patients with late-onset ALI/ARDS had longer ICU and hospital lengths of stay.

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