Ognjen Gajic1, Ousama Dabbagh2, Pauline K. Park3, Adebola Adesanya4, Steven Y. Chang5, Peter Hou6, Harry Anderson, III7, J. Jason Hoth8, Mark E. Mikkelsen9, Nina T. Gentile10, Michelle N. Gong11, Daniel Talmor12, Ednan Bajwa13, Timothy R. Watkins14, Emir Festic15, Murat Yilmaz16, Remzi Iscimen17, David A. Kaufman18, Annette M. Esper19, Ruxana Sadikot20, Ivor Douglas21, Jonathan Sevransky22 and Michael Malinchoc1; on behalf of the U.S. Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG–LIPS),* Published ahead of print on August 27, 2010. American Journal of Respiratory and Critical Care Medicine Vol 183. pp. 462-470, (2011)
Rationale: Accurate, early identification of patients at risk for developing acute lung injury (ALI) provides the opportunity to test and implement secondary prevention strategies.

Objectives: To determine the frequency and outcome of ALI development in patients at risk and validate a lung injury prediction score (LIPS).

Methods: In this prospective multicenter observational cohort study, predisposing conditions and risk modifiers predictive of ALI development were identified from routine clinical data available during initial evaluation. The discrimination of the model was assessed with area under receiver operating curve (AUC). The risk of death from ALI was determined after adjustment for severity of illness and predisposing conditions.

Measurements and Main Results: Twenty-two hospitals enrolled 5,584 patients at risk. ALI developed a median of 2 (interquartile range 1–4) days after initial evaluation in 377 (6.8%; 148 ALI-only, 229 adult respiratory distress syndrome) patients. The frequency of ALI varied according to predisposing conditions (from 3% in pancreatitis to 26% after smoke inhalation). LIPS discriminated patients who developed ALI from those who did not with an AUC of 0.80 (95% confidence interval, 0.78–0.82). When adjusted for severity of illness and predisposing conditions, development of ALI increased the risk of in-hospital death (odds ratio, 4.1; 95% confidence interval, 2.9–5.7).

Conclusions: ALI occurrence varies according to predisposing conditions and carries an independently poor prognosis. Using routinely available clinical data, LIPS identifies patients at high risk for ALI early in the course of their illness. This model will alert clinicians about the risk of ALI and facilitate testing and implementation of ALI prevention strategies.

Clinical trial registered with www.clinicaltrials.gov (NCT00889772).

Key Words: respiratory distress syndrome, adult • prevention • prediction model • acute respiratory failure

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