TY - JOUR
T1 - Lung injury prediction score for the emergency department
T2 - First step towards prevention in patients at risk
AU - Elie-Turenne, Marie Carmelle
AU - Hou, Peter C.
AU - Mitani, Aya
AU - Barry, Jonathan M.
AU - Kao, Erica Y.
AU - Cohen, Jason E.
AU - Frendl, Gyorgy
AU - Gajic, Ognjen
AU - Gentile, Nina T.
N1 - Funding Information:
Dr. Frendl provided internal funding for research staff and biostatistic support from STAR Center, Brigham and Women’s Hospital, Boston, MA. Dr. Gajic is supported in part by grants from the National Heart, Lung, and Blood Institute HL78743-01A1; National Center for Research Resources 1 KL2 RR024151. Dr. Gentile is supported in part by a grant from the National Institute of Neurological Disorders and Stroke 5U10NS059039. The rest of the authors have no disclosures or conflict of interest.
PY - 2012/12
Y1 - 2012/12
N2 - Background: Early identification of patients at risk of developing acute lung injury (ALI) is critical for potential preventive strategies. We aimed to derive and validate an acute lung injury prediction score (EDLIPS) in a multicenter sample of emergency department (ED) patients. Methods: We performed a subgroup analysis of 4,361 ED patients enrolled in the previously reported multicenter observational study. ED risk factors and conditions associated with subsequent ALI development were identified and included in the EDLIPS model. Scores were derived and validated using logistic regression analyses. The model was assessed with the area under the receiver-operating curve (AUC) and compared to the original LIPS model (derived from a population of elective high-risk surgical and ED patients) and the Acute Physiology and Chronic Health Evaluation (APACHE II) score. Results: The incidence of ALI was 7.0% (303/4361). EDLIPS discriminated patients who developed ALI from those who did not with an AUC of 0.78 (95% CI 0.75, 0.82), better than the APACHE II AUC 0.70 (p≤ 0.001) and similar to the original LIPS score AUC 0.80 (p = 0.07). At an EDLIPS cutoff of 5 (range -0.5, 15) positive and negative likelihood ratios (95% CI) for ALI development were 2.74 (2.43, 3.07) and 0.39 (0.30, 0.49), respectively, with a sensitivity 0.72(0.64, 0.78), specificity 0.74 (0.72, 0.76), and positive and negative predictive value of 0.18 (0.15, 0.21) and 0.97 (0.96, 0.98). Conclusion: EDLIPS may help identify patients at risk for ALI development early in the course of their ED presentation. This novel model may detect at-risk patients for treatment optimization and identify potential patients for ALI prevention trials.
AB - Background: Early identification of patients at risk of developing acute lung injury (ALI) is critical for potential preventive strategies. We aimed to derive and validate an acute lung injury prediction score (EDLIPS) in a multicenter sample of emergency department (ED) patients. Methods: We performed a subgroup analysis of 4,361 ED patients enrolled in the previously reported multicenter observational study. ED risk factors and conditions associated with subsequent ALI development were identified and included in the EDLIPS model. Scores were derived and validated using logistic regression analyses. The model was assessed with the area under the receiver-operating curve (AUC) and compared to the original LIPS model (derived from a population of elective high-risk surgical and ED patients) and the Acute Physiology and Chronic Health Evaluation (APACHE II) score. Results: The incidence of ALI was 7.0% (303/4361). EDLIPS discriminated patients who developed ALI from those who did not with an AUC of 0.78 (95% CI 0.75, 0.82), better than the APACHE II AUC 0.70 (p≤ 0.001) and similar to the original LIPS score AUC 0.80 (p = 0.07). At an EDLIPS cutoff of 5 (range -0.5, 15) positive and negative likelihood ratios (95% CI) for ALI development were 2.74 (2.43, 3.07) and 0.39 (0.30, 0.49), respectively, with a sensitivity 0.72(0.64, 0.78), specificity 0.74 (0.72, 0.76), and positive and negative predictive value of 0.18 (0.15, 0.21) and 0.97 (0.96, 0.98). Conclusion: EDLIPS may help identify patients at risk for ALI development early in the course of their ED presentation. This novel model may detect at-risk patients for treatment optimization and identify potential patients for ALI prevention trials.
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U2 - 10.1186/1865-1380-5-33
DO - 10.1186/1865-1380-5-33
M3 - Article
AN - SCOPUS:84887025011
SN - 1865-1372
VL - 5
JO - International Journal of Emergency Medicine
JF - International Journal of Emergency Medicine
IS - 1
M1 - 33
ER -