Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS.

Pubmed ID: 29903755

Pubmed Central ID: PMC6410734

Journal: Thorax

Publication Date: Sept. 1, 2018

Affiliation: Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.

Link: https://thorax.bmj.com/content/thoraxjnl/73/9/840.full.pdf?link_time=2024-03-29_04:51:21.960225

MeSH Terms: Humans, Male, Adult, Female, Cohort Studies, Middle Aged, Prognosis, Severity of Illness Index, Predictive Value of Tests, Pulmonary Edema, Radiography, Respiratory Distress Syndrome

Grants: R37 HL051856, K24 HL103836, T32 HL087738, R01 HL131621, R01 HL126176, R01 HL126671, K08 HL136888

Authors: Matthay MA, Ware LB, Calfee CS, Bastarache JA, Zhao Z, Koyama T, Warren MA, Shaver CM, Semler MW, Rice TW

Cite As: Warren MA, Zhao Z, Koyama T, Bastarache JA, Shaver CM, Semler MW, Rice TW, Matthay MA, Calfee CS, Ware LB. Severity scoring of lung oedema on the chest radiograph is associated with clinical outcomes in ARDS. Thorax 2018 Sep;73(9):840-846. Epub 2018 Jun 14.

Studies:

Abstract

BACKGROUND: There is no accurate, non-invasive measurement to estimate the degree of pulmonary oedema in acute respiratory distress syndrome (ARDS). We developed the Radiographic Assessment of Lung Oedema (RALE) score to evaluate the extent and density of alveolar opacities on chest radiographs. After first comparing the RALE score to gravimetric assessment of pulmonary oedema in organ donors, we then evaluated the RALE score in patients with ARDS for its relationship to oxygenation and clinical outcomes. METHODS: We compared radiographs with excised lung weights from 72 organ donors (derivation cohort) and radiographs with clinical data from 174 patients with ARDS in the ARDSNet Fluid and Catheter Treatment Trial (validation cohort). To calculate RALE, each radiographic quadrant was scored for extent of consolidation (0-4) and density of opacification (1-3). The product of the consolidation and density scores for each of the four quadrants was summed (maximum score=48). RESULTS: Agreement between two independent reviewers for RALE score was excellent (intraclass correlation coefficient=0.93, 95% CI 0.91 to 0.95). In donors, pre-procurement RALE score correlated with height-adjusted total lung weight (ρ=0.59, p&lt;0.001). In patients with ARDS, higher RALE scores were independently associated with lower PaO<sub>2</sub>/fractional inspired oxygen and worse survival. Conservative fluid management significantly decreased RALE score over 3 days compared with liberal fluid management. CONCLUSIONS: The RALE score can be used to assess both the extent of pulmonary oedema and the severity of ARDS, by utilising information that is already obtained routinely, safely and inexpensively in every patient with ARDS. This novel non-invasive measure should be useful for assessing ARDS severity and monitoring response to therapy.