Journal Article

Understanding patient outcomes after acute respiratory distress syndrome: identifying subtypes of physical, cognitive and mental health outcomes

Hopkins, Ramona O, Presson, Angela P, Greene, Tom, Wilson, Emily L, Needham, Dale M, Brown, Samuel M, Dinglas, Victor D

2017

Overview

PurposeWith improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding survivors’ posthospitalisation outcomes is increasingly important. However, little is known regarding associations among physical, cognitive and mental health outcomes. Identification of outcome subtypes may advance understanding of post-ARDS morbidities.MethodsWe analysed baseline variables and 6-month health status for participants in the ARDS Network Long-Term Outcomes Study. After division into derivation and validation datasets, we used weighted network analysis to identify subtypes from predictors and outcomes in the derivation dataset. We then used recursive partitioning to develop a subtype classification rule and assessed adequacy of the classification rule using a kappa statistic with the validation dataset.ResultsAmong 645 ARDS survivors, 430 were in the derivation and 215 in the validation datasets. Physical and mental health status, but not cognitive status, were closely associated. Four distinct subtypes were apparent (percentages in the derivation cohort): (1) mildly impaired physical and mental health (22% of patients), (2) moderately impaired physical and mental health (39%), (3) severely impaired physical health with moderately impaired mental health (15%) and (4) severely impaired physical and mental health (24%). The classification rule had high agreement (kappa=0.89 in validation dataset). Female Latino smokers had the poorest status, while male, non-Latino non-smokers had the best status.ConclusionsWe identified four post-ARDS outcome subtypes that were predicted by sex, ethnicity, pre-ARDS smoking status and other baseline factors. These subtypes may help develop tailored rehabilitation strategies, including investigation of combined physical and mental health interventions, and distinct interventions to improve cognitive outcomes.

• Publisher: BMJ Publishing Group LTD
• Subject: Acute Disease / Adult / Age Factors / Clinical outcomes / Cluster analysis / Cognition Disorders - ethnology / Cognition Disorders - etiology / Comorbidity / Datasets / Female / Follow-Up Studies / Hispanic or Latino - statistics & numerical data / Humans / Identification / Illnesses / Intensive care / Male / Mental Disorders - ethnology / Mental Disorders - etiology / Mental health / Middle Aged / Patients / Precision medicine / Prognosis / Psychiatric Status Rating Scales / Quality of Life / Respiratory distress syndrome / Respiratory Distress Syndrome - ethnology / Respiratory Distress Syndrome - psychology / Respiratory Distress Syndrome - rehabilitation / Risk Factors / Severity of Illness Index / Sex Factors / Smoking - ethnology / Statistical methods / Studies / United States - epidemiology / Ventilators