• Daniel Kotok, Libing Yang, John W Evankovich, William Bain, Daniel G Dunlap, Faraaz Shah, Yingze Zhang, Dimitris V Manatakis, Panayiotis V Benos, Ian J Barbash, Sarah F Rapport, Janet S Lee, Alison Morris, Bryan J McVerry, and Georgios D Kitsios.
• Internal Medicine Residency Program, University of Pittsburgh Medical Center McKeesport, USA.
• J Crit Care. 2020 Apr 1; 56: 222228222-228.

PurposeTo assess the longitudinal evolution of radiographic edema using chest X-rays (CXR) in patients with Acute Respiratory Distress Syndrome (ARDS) and to examine its association with prognostic biomarkers, ARDS subphenotypes and outcomes.Materials And MethodsWe quantified radiographic edema on CXRs from patients with ARDS or cardiogenic pulmonary edema (controls) using the Radiographic Assessment of Lung Edema (RALE) score on day of intubation and up to 10 days after. We measured baseline plasma biomarkers and recorded clinical variables.ResultsThe RALE score had good inter-rater agreement (r = 0.83, p < 0.0001) applied on 488 CXRs from 129 patients, with higher RALE scores in patients with ARDS (n = 108) compared to controls (n = 21, p = 0.01). Baseline RALE scores were positively correlated with levels of the receptor for end-glycation end products (RAGE) in ARDS patients (p < 0.05). Baseline RALE scores were not predictive of 30- or 90-day survival. Persistently elevated RALE scores were associated with prolonged need for mechanical ventilation (p = 0.002).ConclusionsThe RALE score is easily implementable with high inter-rater reliability. Longitudinal RALE scoring appears to be a reproducible approach to track the evolution of radiographic edema in patients with ARDS and can potentially predict prolonged need for mechanical ventilation.Copyright © 2020 Elsevier Inc. All rights reserved.

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