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Original Research: Critical Care |

Comparison of Hospital Mortality and Long-term Survival in Patients With Acute Lung Injury/ARDS vs Cardiogenic Pulmonary EdemaSurvival After ARDS vs Cardiogenic Pulmonary Edema

Christopher N. Schmickl, MD, MPH; Michelle Biehl, MD; Gregory A. Wilson, RRT; Ognjen Gajic, MD, FCCP
Author and Funding Information

From M.E.T.R.I.C. (Multidisciplinary Epidemiology and Translational Research in Intensive Care) (Drs Schmickl, Biehl, and Gajic and Mr Wilson), Division of Pulmonary and Critical Care Medicine, and the Department of Pulmonary and Critical Care Medicine (Drs Biehl and Gajic), Mayo Clinic, Rochester, MN; and the University Witten-Herdecke (Dr Schmickl), Witten, Germany.

CORRESPONDENCE TO: Christopher N. Schmickl, MD, MPH, Schnieglingerstrasse 225, 90427 Nuremberg, Germany; e-mail: christopher.schmickl@mail.harvard.edu


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):618-625. doi:10.1378/chest.14-1371
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BACKGROUND:  Early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE) is important for selecting the most appropriate therapy, but the prognostic implications of this distinction have not been studied. Accurate prognostic information is essential for providing appropriate informed consent prior to initiation of mechanical ventilation.

METHODS:  This is a long-term follow-up study of a previously established population-based cohort of critically ill adult patients with acute pulmonary edema admitted at a tertiary-care center during 2006 to 2009, in which post hoc expert review had established ALI vs CPE diagnosis. Using logistic and Cox regression, hospital mortality and long-term survival were compared in patients with ALI vs patients with CPE.

RESULTS:  Of 328 patients (ALI = 155, CPE = 173), 240 patients (73%) died during a median follow-up of 160 days. After adjusting for confounders, patients with ALI were significantly more likely to die in the hospital (OR = 4.2, 95% CI = 2.3-7.8, n = 325, P < .001), but among hospital survivors the risk of death during follow-up was the same in both groups (hazard ratio = 1.13, 95% CI = 0.79-1.62, n = 229, P = .50). Independent predictors of mortality included age and APACHE (Acute Physiology and Chronic Health Evaluation) III score. Results were similar when restricting patients with ALI to the subset with ARDS (Berlin definition). In post hoc analyses, the mortality rate in hospital survivors compared with the general US population was significantly higher during the first 2 years but essentially converged by year five.

CONCLUSIONS:  Although hospital mortality is higher in patients with ALI/ARDS compared with patients with CPE, long-term survival is similar in hospital survivors from both groups.

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