Incidence and Outcomes of Acute Respiratory Distress Syndrome

Abstract

Most epidemiological studies of acute respiratory distress syndrome (ARDS) have been conducted in western countries, and studies in Asia are limited. The aim of our study was to evaluate the incidence, in-hospital mortality, and 1-year mortality of ARDS in Taiwan.We conducted a nationwide inpatient cohort study based on the Taiwan National Health Insurance Research Database between 1997 and 2011. A total of 40,876 ARDS patients (68% male; mean age 66 years) were identified by International Classification of Diseases, 9th edition coding and further analyzed for clinical characteristics, medical costs, and mortality.The overall crude incidence of ARDS was 15.74 per 100,000 person-years, and increased from 2.53 to 19.26 per 100,000 person-years during the study period. The age-adjusted incidence of ARDS was 15.19 per 100,000 person-years. The overall in-hospital mortality was 57.8%. In-hospital mortality decreased from 59.7% in 1997 to 47.5% in 2011 (P < 0.001). The in-hospital mortality rate was lowest (33.5%) in the youngest patients (age 18–29 years) and highest (68.2%) in the oldest patients (>80 years, P < 0.001). The overall 1-year mortality rate was 72.1%, and decreased from 75.8% to 54.7% during the study period. Patients who died during hospitalization were older (69 ± 17 versus 62 ± 19, P < 0.001) and predominantly male (69.8% versus 65.3%, P < 0.001). In addition, patients who died during hospitalization had significantly higher medical costs (6421 versus 5825 US Dollars, P < 0.001) and shorter lengths of stay (13 versus 19 days, P < 0.001) than patients who survived.We provide the first large-scale epidemiological analysis of ARDS incidence and outcomes in Asia. Although the overall incidence was lower than has been reported in a prospective US study, this may reflect underdiagnosis by International Classification of Diseases, 9th edition code and identification of only patients with more severe ARDS in this analysis. Overall, there has been a decreasing trend in in-hospital and 1-year mortality rates in recent years, likely because of the implementation of lung-protective ventilation.

Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: A meta-analysis

“…In the last decade, numerous approaches have been proposed to treat ARDS, such as improvements in fluid administration, non-invasive mechanical ventilation strategies and ventilator management ( 6 – 9 ). Although in-hospital and 1-year mortality rates have decreased by a certain degree in recent years, ARDS still leads to a heavy social burden and high health-care cost ( 10 , 11 ).…”

MicroRNA Regulation of Acute Lung Injury and Acute Respiratory Distress Syndrome

“…Whereas, European estimates are more conservative, ranging between 4.2 and 13.5/100,000 per year (Webster et al, 1988;Luhr et al, 1999). However, epidemiological studies conducted in Asia are limited (Singh et al, 2014;Chen et al, 2015). A recent systemic review suggests that the mortality rate for ARDS is between 36% and 44% (Phua et al, 2009).…”

Definitions, Epidemiology, Clinical Risk Factors, and Health Disparities in Acute Respiratory Distress Syndrome

“…27 A study of hospital discharges in Taiwan also demonstrated an increase in ARDS population incidence from 3 to 19 cases per 100,000 persons per year from 1997 to 2011. 43 In contrast, a third study from 2001 to 2008 in Olmsted County, Minnesota, demonstrated a decrease in ARDS incidence from 82 to 39 cases per 100,000 persons per year. While these studies are informative for their respective populations and to the extent that the Olmsted study generated hypotheses for preventing ARDS through hospital-wide health care practices, the geographic variation of the incidence of ARDS advises toward caution in extrapolating these trends to other contexts.…”