Development and Internal Validation of a Novel Prognostic Score to Predict Mortality in Acute Respiratory Distress Syndrome - Driving Pressure, Oxygenation and Nutritional Evaluation - "DRONE Score".

IF 1.2 Q3 EMERGENCY MEDICINE Journal of Emergencies, Trauma, and Shock Pub Date : 2023-07-01 Epub Date: 2023-05-22 DOI:10.4103/jets.jets_12_23

Pratibha Todur, Anitha Nileshwar, Souvik Chaudhuri, Shwethapriya Rao, Vishal Shanbhag, Sriharsha Tatineni

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引用次数: 1

Abstract

Introduction: There are few scores for mortality prediction in acute respiratory distress syndrome (ARDS) incorporating comprehensive ventilatory, acute physiological, organ dysfunction, oxygenation, and nutritional parameters. This study aims to determine the risk factors of ARDS mortality from the above-mentioned parameters at 48 h of invasive mechanical ventilation (IMV), which are feasible across most intensive care unit settings.

Methods: Prospective, observational, single-center study with 150 patients with ARDS defined by Berlin definition, receiving IMV with lung protective strategy.

Results: Our study had a mortality of 41.3% (62/150). We developed a 9-point novel prediction score, the driving pressure oxygenation and nutritional evaluation (DRONE) score comprising of driving pressure (DP), oxygenation accessed by the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO₂/FiO₂) ratio and nutritional evaluation using the modified nutrition risk in the critically ill (mNUTRIC) score. Each component of the DRONE score with the cutoff value to predict mortality was assigned a particular score (the lowest DP within 48 h in a patient being always ≥15 cmH₂O a score of 2, the highest achievable PaO₂/FiO₂ <208 was assigned a score of 4 and the mNUTRIC score ≥4 was assigned a score of (3). We obtained the DRONE score ≥4, area under the curve 0.860 to predict mortality. Cox regression for the DRONE score >4 was highly associated with mortality (P < 0.001, hazard ratio 5.43, 95% confidence interval [2.94-10.047]). Internal validation was done by bootstrap analysis. The clinical utility of the DRONE score ≥4 was assessed by Kaplan-Meier curve which showed significance.

Conclusions: The DRONE score ≥4 could be a reliable predictor of mortality at 48 h in ARDS patients receiving IMV.

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一种预测急性呼吸窘迫综合征死亡率的新型预后评分的开发和内部验证——驾驶压力、氧合和营养评估——“DRONE评分”。

摘要:目前对急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)进行综合通气、急性生理、器官功能障碍、氧合和营养参数的死亡率预测评分很少。本研究旨在通过上述参数确定有创机械通气(IMV) 48 h时ARDS死亡率的危险因素，这在大多数重症监护病房环境中都是可行的。方法:前瞻性、观察性、单中心研究，纳入150例经柏林定义的ARDS患者，接受IMV治疗并采取肺保护策略。结果:本研究死亡率为41.3%(62/150)。我们开发了一种新的9分预测评分，即驾驶压力氧合和营养评估(DRONE)评分，包括驾驶压力(DP)、动脉氧分压与吸入氧分数(PaO2/FiO2)比获得的氧合以及使用改进的危重症营养风险(mNUTRIC)评分进行的营养评估。具有预测死亡率临界值的DRONE评分的每个组成部分都被赋予一个特定的评分(患者48小时内最低DP≥15 cmH2O评分为2分，可达到的最高PaO2/FiO2 4与死亡率高度相关(P < 0.001，风险比5.43,95%置信区间[2.94-10.047])。内部验证通过自举分析完成。Kaplan-Meier曲线评价DRONE评分≥4分的临床应用价值，有统计学意义。结论:DRONE评分≥4分可作为接受IMV治疗的ARDS患者48 h死亡率的可靠预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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