Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study

Background: Identification of acute respiratory distress syndrome (ARDS) from patients with severe pneumonia remains a significant clinical problem due to the overlap of clinical presentations. Aims To identify risk factors associated with ARDS development and prognosis in order to early recognize ARDS from severe pneumonia. Methods: From April 2014 to December 2015, patients with severe pneumonia at admission were retrieved from the hospital database, of which ARDS developed within 7 days were further identified. We identified potential predictors for ARDS development and mortality, and performed multivariate logistic regression and receiver operating characteristic curves to screen independent risk factors and calculate their sensitivity in predicting ARDS development and prognosis. Results: Compared with severe pneumonia without ARDS development, patients with ARDS development had shorter disease duration before admission, higher lung injury score, serum fibrinogen (FiB), and positive end-expiratory pressure (PEEP), but similar mortality. Serum FiB > 5.15g/L (adjusted OR 1.893, 95%CI 1.141-3.142, P = 0.014) and PEEP > 6.5cmH2O (adjusted OR 1.651, 95%CI 1.218-2.237, P = 0.001) were independent predictors for ARDS development with a sensitivity of 58.3% and 87.5%, respectively, and pH Conclusions: ARDS development risk could be early recognized by PEEP > 6.5cmH2O and serum FiB > 5.15g/L in severe pneumonia patients, and pH