Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS

Jabaudon, Matthieu; Audard, Jules; Pereira, Bruno; Jaber, Samir; Lefrant, Jean‐Yves; Futier, Emmanuel; Lambert, Céline; Bazin, Jean-Étienne; Bastarache, Julie A.; Constantin, Jean-Michel; Ware, Lorraine B.; Souweine, Bertrand; Eisenmann, Nathanaël; Quenot, Jean-Pierre; Séguin, Philippe; Asehnoune, Karim; Lasocki, Sigismond; Ferrandière, Martine; Sossou, Achile; Langeron, Olivier; Léone, Marc; Dupont, Hervé; Veber, Benoît; Ichaï, Carole; Rimmelé, Thomas; Legay, François; Grelon, Fabien; Dahyot‐Fizelier, Claire; Cayot, Sophie; Godet, Thomas; Renaud, G.; Verlhac, Camille; Chabanne, Russell; Bernard, Cosserant; Blondonnet, Raïko; Lautrette, Alexandre; Muller, Laurent; Massanet, Pablo; Caroline, Boutin; Barbar, Saber; Claire, Roger; Belafia, Fouad; Cisse, Moussa; Marion, Monnin; Conseil, Matthieu; Carr, Julie; Jong, Audrey De; Chanques, Gérald; Auguste, Dargent; Crozon, Thomas; Clauzel, Julien; Core, Marinne Le; Andreu, Pascal; Lebouvrier, Thomas; Launey, Yoann; Antoine, Roquilly; Cinotti, Raphaël; Anne-Charlotte, Tellier; Barbaz, Mathilde; Cohen, Benjamin L.; Edouard, Lemarche; Bertrand, Pierre-Marie; Arbelot, Charlotte; Zieleskiewicz, Laurent; Emmanuelle, Hammad; Duclos, Garry; Mathieu, Chantal; Jean-Christophe, Orban; Hervé, Quintard; Assefi, Mona; Morel, J.; Molliex, Serge; Frank, Petitas; Nanadougmar, Hadanou

doi:10.1016/j.chest.2020.06.070

Cited by 36 publications

(47 citation statements)

References 25 publications

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“…Although we could not find an association between baseline RALE and mortality, a recent study proposes that the change in RALE score in the first days is associated with survival in ARDS ( Jabaudon et al, 2020 ). Also in patients with pneumonia from coronavirus disease, both the visually scored and RALE score and the ones computed from artificial intelligence algorithms were associated with poor outcomes ( Ebrahimian et al, 2021 ).…”

Section: Discussioncontrasting

confidence: 99%

Accuracy of the Radiographic Assessment of Lung Edema Score for the Diagnosis of ARDS

Zimatore

Pisani

Lippolis³

et al. 2021

Front. Physiol.

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Background: Bilateral opacities on chest radiographs are part of the Berlin Definition for Acute Respiratory Distress Syndrome (ARDS) but have poor interobserver reliability. The “Radiographic Assessment of Lung Edema” (RALE) score was recently proposed for evaluation of the extent and density of alveolar opacities on chest radiographs of ARDS patients. The current study determined the accuracy of the RALE score for the diagnosis and the prognosis of ARDS.Methods:Post-hoc analysis of a cohort of invasively ventilated intensive care unit (ICU) patients expected to need invasive ventilation for >24 h. The Berlin Definition was used as the gold standard. The RALE score was calculated for the first available chest radiograph after start of ventilation in the ICU. The primary endpoint was the diagnostic accuracy for ARDS of the RALE score. Secondary endpoints included the prognostic value of the RALE score for ICU and hospital mortality, and the association with ARDS severity, and the PaO2/FiO2. Receiver operating characteristic (ROC) curves were constructed, and the optimal cutoff was used to determine sensitivity, specificity and the negative and positive predictive value of the RALE score for ARDS.Results: The study included 131 patients, of whom 30 had ARDS (11 mild, 15 moderate, and 4 severe ARDS). The first available chest radiograph was obtained median 0 [0 to 1] days after start of invasive ventilation in ICU. Compared to patients without ARDS, a higher RALE score was found in patients with ARDS (24 [interquartile range (IQR) 16–30] vs. 6 [IQR 3–11]; P < 0.001), with RALE scores of 20 [IQR 14–24], 26 [IQR 16–32], and 32 [IQR 19–36] for mild, moderate and severe ARDS, respectively, (P = 0.166). The area under the ROC for ARDS was excellent (0.91 [0.86–0.96]). The best cutoff for ARDS diagnosis was 10 with 100% sensitivity, 71% specificity, 51% positive predictive value and 100% negative predictive value. The RALE score was not associated with ICU or hospital mortality, and weakly correlated with the PaO2/FiO2.Conclusion: In this cohort of invasively ventilated ICU patients, the RALE score had excellent diagnostic accuracy for ARDS.

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Section: Discussioncontrasting

confidence: 99%

Accuracy of the Radiographic Assessment of Lung Edema Score for the Diagnosis of ARDS

Zimatore

Pisani

Lippolis³

et al. 2021

Front. Physiol.

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“…In ALI/ARDS, DAD leads to the release of proinflammatory cytokines, which further recruit neutrophils to the lungs, exacerbating local and systemic inflammation and tissue injury [32]. Locally damaged endothelial cells allow for protein-rich fluid leaking into the alveoli and the interstitium, contributing to the devastating ALI/ARDS pathology [33]. In the present study, decreased miR-181a-5p and increased MALAT1 were detected in both ALI/ARDS patient plasma, leading us to further explore the HPMECs regarding these two RNAs.…”

Section: Discussionmentioning

confidence: 99%

RETRACTED: Targeting MALAT1 and miRNA-181a-5p for the intervention of acute lung injury/acute respiratory distress syndrome

Liu¹,

Wang²,

Li³

et al. 2020

Respiratory Medicine

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Background: ALI/ARDS is a severe lung injury leading to refractory respiratory failure, accounting for high morbidity and mortality. However, therapeutic approaches are rather limited. Targeting long non-coding RNA MALAT1 and microRNA miR-181a-5p might be potential option for ALI/ARDS intervention. Objective: We aimed to investigate the role of MALAT and miR-181a-5p in the pathogenesis of ALI/ARDS, and test the therapeutic effects of targeting MALAT and miR-181a-5p for ALI/ARDS intervention in vitro. Methods: MALAT1 and miR-181a-5p levels were measured in plasma from ALI/ARDS patients. In vitro human pulmonary microvascular endothelial cell (HPMEC) injury was induced by LPS treatment, and molecular targets of MALAT1 and miR-181a-5p were explored by molecular biology approaches, mainly focusing on cell apoptosis and vascular inflammation. Interaction between MALAT1 and miR-181a-5p was also detected. Finally, the effects of targeting MALAT1 and miR-181a-5p for ALI/ARDS intervention were validated in a rat ALI/ARDS model. Results: MALAT1 upregulation and miR-181a-5p downregulation were observed in ALI/ARDS patients. Transfection of mimic miR-181a-5p into HPMECs revealed decreased Fas and apoptosis, along with reduced inflammatory factors. Fas was proved to be a direct target of miR-181a-5p. Similar effects were also present upon MALAT1 knockdown. As for the interaction between MALAT1 and miR-181a-5p, MALAT1 knockdown increased miR-181a-5p expression. Knocking down of MALAT1 and miR-181a-5p could both improve the outcome in ALI/ ARDS rats. Conclusion: MALAT1 antagonism or miR-181a-5p could both be potential therapeutic strategies for ALI/ARDS. Mechanistically, miR-181a-5p directly inhibits Fas and apoptosis, along with reduced inflammation. MALAT1 negatively regulates miR-181a-5p.

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“…The radiological involvement was classified according to the radiographic assessment of lung oedema (RALE) 14 . To calculate the RALE score, the chest was divided into 4 quadrants.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of opportunistic invasive aspergillosis in COVID‐19 patients with severe pneumonia

Segrelles‐Calvo

Araújo

Llopis-Pastor

et al. 2020

Mycoses

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Background As the global coronavirus pandemic (COVID‐19) spreads across the world, new clinical challenges emerge in the hospital landscape. Among these challenges, the increased risk of coinfections is a major threat to the patients. Although still in a low number, due to the short time of the pandemic, studies that identified a significant number of hospitalised patients with COVID‐19 who developed secondary fungal infections that led to serious complications and even death have been published. Objectives In this scenario, we aim to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Patients/Methods We designed an open prospective observational study at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. Results In this article, we reported seven patients with COVID‐19‐associated pulmonary aspergillosis (CAPA) who had a poor prognosis. Severely ill patients represent a high‐risk group; therefore, we must actively investigate the possibility of aspergillosis in all of these patients. Larger cohort studies are needed to unravel the role of COVID‐19 immunosuppressive therapy as a risk factor for aspergillosis. Conclusions As the pandemic continues to spread across the world, further reports are needed to assess the frequency of emergent and highly resistant reemergent fungal infections during severe COVID‐19. These coinfections are leading a significant number of patients with COVID‐19 to death due to complications following the primary viral disease.

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Early Changes Over Time in the Radiographic Assessment of Lung Edema Score Are Associated With Survival in ARDS

Cited by 36 publications

References 25 publications

Accuracy of the Radiographic Assessment of Lung Edema Score for the Diagnosis of ARDS

Accuracy of the Radiographic Assessment of Lung Edema Score for the Diagnosis of ARDS

RETRACTED: Targeting MALAT1 and miRNA-181a-5p for the intervention of acute lung injury/acute respiratory distress syndrome

Prevalence of opportunistic invasive aspergillosis in COVID‐19 patients with severe pneumonia

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