• Jesús Villar, Jesús M González-Martín, Alfonso Ambrós, Fernando Mosteiro, Domingo Martínez, Lorena Fernández, Juan A Soler, Laura Parra, Rosario Solano, Marina Soro, Rafael Del Campo, Raúl I González-Luengo, Belén Civantos, Raquel Montiel, Lidia Pita-García, Anxela Vidal, José M Añón, Carlos Ferrando, Francisco J Díaz-Domínguez, Juan M Mora-Ordoñez, M Mar Fernández, Cristina Fernández, Rosa L Fernández, Pedro Rodríguez-Suárez, Ewout W Steyerberg, Robert M Kacmarek, and Spanish Initiative for Epidemiology, Stratification and Therapies of ARDS (SIESTA) Network.
• CIBER de Enfermedades Respiratorias, Instituto Salud Carlos III, Madrid, Spain.
• Crit. Care Med. 2021 Oct 1; 49 (10): e920e930e920-e930.

ObjectivesTo develop a scoring model for stratifying patients with acute respiratory distress syndrome into risk categories (Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score) for early prediction of death in the ICU, independent of the underlying disease and cause of death.DesignA development and validation study using clinical data from four prospective, multicenter, observational cohorts.SettingA network of multidisciplinary ICUs.PatientsOne-thousand three-hundred one patients with moderate-to-severe acute respiratory distress syndrome managed with lung-protective ventilation.InterventionsNone.Measurements And Main ResultsThe study followed Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines for prediction models. We performed logistic regression analysis, bootstrapping, and internal-external validation of prediction models with variables collected within 24 hours of acute respiratory distress syndrome diagnosis in 1,000 patients for model development. Primary outcome was ICU death. The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score was based on patient's age, number of extrapulmonary organ failures, values of end-inspiratory plateau pressure, and ratio of Pao2 to Fio2 assessed at 24 hours of acute respiratory distress syndrome diagnosis. The pooled area under the receiver operating characteristic curve across internal-external validations was 0.860 (95% CI, 0.831-0.890). External validation in a new cohort of 301 acute respiratory distress syndrome patients confirmed the accuracy and robustness of the scoring model (area under the receiver operating characteristic curve = 0.870; 95% CI, 0.829-0.911). The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score stratified patients in three distinct prognostic classes and achieved better prediction of ICU death than ratio of Pao2 to Fio2 at acute respiratory distress syndrome onset or at 24 hours, Acute Physiology and Chronic Health Evaluation II score, or Sequential Organ Failure Assessment scale.ConclusionsThe Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score represents a novel strategy for early stratification of acute respiratory distress syndrome patients into prognostic categories and for selecting patients for therapeutic trials.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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