Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome

This article is hot off the press.  A new mortality predictor for ARDS with high probability. Unfortunately, it is not an Open Access article.  Hopefully like me you have some sort of institutional access to read the full paper.

TITLE: Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome[1]

AUTHORS: Jesús Villar, Alfonso Ambrós, Juan Alfonso Soler, Domingo Martínez, Carlos Ferrando, Rosario Solano, Fernando Mosteiro, Jesús Blanco, Carmen Martín-Rodríguez, María Del Mar Fernández, Julia López, Francisco J Díaz-Domínguez, David Andaluz-Ojeda, Eleuterio Merayo, Lina Pérez-Méndez, Rosa Lidia Fernández, Robert M Kacmarek

Critical Care Medicine 2016 March 31
OBJECTIVES: Although there is general agreement on the characteristic features of the acute respiratory distress syndrome, we lack a scoring system that predicts acute respiratory distress syndrome outcome with high probability. Our objective was to develop an outcome score that clinicians could easily calculate at the bedside to predict the risk of death of acute respiratory distress syndrome patients 24 hours after diagnosis.

DESIGN: A prospective, multicenter, observational, descriptive, and validation study.

SETTING: A network of multidisciplinary ICUs.

PATIENTS: Six-hundred patients meeting Berlin criteria for moderate and severe acute respiratory distress syndrome enrolled in two independent cohorts treated with lung-protective ventilation.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using individual demographic, pulmonary, and systemic data at 24 hours after acute respiratory distress syndrome diagnosis, we derived our prediction score in 300 acute respiratory distress syndrome patients based on stratification of variable values into tertiles, and validated in an independent cohort of 300 acute respiratory distress syndrome patients. Primary outcome was in-hospital mortality. We found that a 9-point score based on patient’s age, PaO2/FIO2 ratio, and plateau pressure at 24 hours after acute respiratory distress syndrome diagnosis was associated with death. Patients with a score greater than 7 had a mortality of 83.3% (relative risk, 5.7; 95% CI, 3.0-11.0), whereas patients with scores less than 5 had a mortality of 14.5% (p < 0.0000001). We confirmed the predictive validity of the score in a validation cohort.

CONCLUSIONS: A simple 9-point score based on the values of age, PaO2/FIO2 ratio, and plateau pressure calculated at 24 hours on protective ventilation after acute respiratory distress syndrome diagnosis could be used in real time for rating prognosis of acute respiratory distress syndrome patients with high probability.


  1. Villar J, Ambrós A, Soler J, Martínez D, Ferrando C, Solano R, Mosteiro F, Blanco J, Martín-Rodríguez C, Fernández M, López J, Díaz-Domínguez F, Andaluz-Ojeda D, Merayo E, Pérez-Méndez L, Fernández R, Kacmarek R, Stratification and. Age, PaO2/FIO2, and Plateau Pressure Score: A Proposal for a Simple Outcome Score in Patients With the Acute Respiratory Distress Syndrome. Crit Care Med 2016; PMID: 27035239