• Chest · Dec 2020

    Randomized Controlled Trial Multicenter Study

    Early Changes over Time in the Radiographic Assessment of Lung Edema (RALE) Score are Associated with Survival in Acute Respiratory Distress Syndrome.

    • Matthieu Jabaudon, Jules Audard, Bruno Pereira, Samir Jaber, Jean-Yves Lefrant, Raiko Blondonnet, Thomas Godet, Emmanuel Futier, Céline Lambert, Jean-Etienne Bazin, Julie A Bastarache, Jean-Michel Constantin, Lorraine B Ware, and LIVE Study Group and the AZUREA Network.
    • Department of Perioperative Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France; GReD, CNRS UMR 6293, INSERM U1103, Université Clermont Auvergne, Clermont-Ferrand, France; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: mjabaudon@chu-clermontferrand.fr.
    • Chest. 2020 Dec 1; 158 (6): 2394-2403.

    BackgroundThe Radiographic Assessment of Lung Edema (RALE) score is associated with the severity of ARDS, and treatments targeted at reducing pulmonary edema such as conservative fluid management cause a reduction in RALE score over time.Research QuestionAre early changes in RALE score over time associated with survival in patients with ARDS?Study Design And MethodsData from patients enrolled in three centers in the Lung Imaging for Ventilation sEtting in ARDS (LIVE) trial with available chest radiographs at baseline (day 0) and days 2 or 3 were used. The RALE was scored by two independent reviewers. The primary end point was death by day 90, considering RALE score both at baseline and as a time-varying covariate in a marginal Cox survival model.ResultsRALE was scored from 135, 64, and 88 radiographs on days 0, 2, and 3, respectively. Both baseline RALE (hazard ratio [HR] for each one-point increment, 1.04; 95% CI, 1.01-1.08; P = .006) and the change in RALE over time (HR for each one-point decrease per unit of time, 0.99; 95% CI, 0.99-0.99; P = .03) were associated with death by day 90, even after adjustment for age, sex, BMI, Simplified Acute Physiology Score II, vasopressor use, and total volume of fluids received since study entry.InterpretationThe change in RALE during the first days after ARDS onset is independently associated with survival and may be useful as a surrogate end point in future clinical trials of new therapeutics in ARDS.Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

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