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Part One Milan, Italy Intensive Care Medicine Experimental 2016, 4(Suppl 1):27 Intensive Care Medicine DOI 10.1186/s40635-016-0098-x Experimental MEETING ABSTRACTS Open Access ESICM LIVES 2016: part one Milan, Italy. 1-5 October 2016 Published: 29 September 2016 About this supplement These abstracts have been published as part of Intensive Care Medicine Experimental Volume 4 Suppl 1, 2016. The full contents of the supplement are available online at http://icm-experimental.springeropen.com/articles/supplements/volume-3-supplement-1. Please note that this is part 1 of 3. Oral Sessions. ARDS: CLINICAL STUDIES Grant acknowledgement This study is supported by the MARS consortium, a public-private A1 partnership. Identification of distinct endophenotypes in patients with acute respiratory distress syndrome by unbiased cluster analysis, and their association with mortality Table 1 (abstract A1). Endophenotypes versus clinical characteristics 1 1 1 1 2 2 Impassive N=383 Intermediate N=224 Reactive N=164 P-value L. Bos , L. Schouten , L. van Vught , M. Wiewel , D. Ong , O. Cremer ,A. endophenotype endophenotype endophenotype 3 4 1 1 1 Artigas , I. Martin-Loeches , A. Hoogendijk , T. van der Poll , J. Horn ,N. Age 63 (53.5-72) 61.5 (51.8-72) 58 (45-66) <0.001 1 1 Juffermans , M. Schultz Male 252 (65.8) 129 (57.6) 107 (65.2) 0.1 1Academic Medical Center, University of Amsterdam, Amsterdam, 2 3 APACHE IV 72 (58-92) 83 (67.5-102) 104.5 (84-124) <0.001 Netherlands; UMCU, Utrecht, Netherlands; Autonomous University of Score 4 Barcelona, Barcelona, Spain; Hospital São Francisco Xavier, Lisbon, Portugal SOFA: 7 (5-9) 9 (7-11) 11 (9-14) <0.001 Correspondence: L. Bos – Academic Medical Center, University of Total score Amsterdam, Amsterdam, Netherlands PaO2/FiO2 191.1 (138-260) 183.2 (146-234) 173.3 (124-225) <0.001 Intensive Care Medicine Experimental 2016, 4(Suppl 1):A1 PEEP 8 (5-11) 9 (6-12) 12 (10-15) <0.001 Days free 20 (8-25) 18 (0-24) 0 (0-18) <0.001 <0.001 of MV at Introduction: Pharmacological immunomodulatory interventions in day 28 'acute respiratory distress syndrome' (ARDS) have been unsuccessful ICU 61 (15.9) 60 (26.8) 76 (46.3) <0.001 in clinical trials [1-3] despite promising results in preclinical studies Mortality using animals [4-5]. Poor phenotyping of patients could be respon- 30-Day 75 (19.6) 70 (31.2) 78 (47.8) <0.001 Mortality sible for these disappointing results. Objectives: We hypothesized that ARDS patients can be clustered based on concentrations of plasma biomarkers and that such bio- logical endophenotypes are association with clinical outcomes. A2 Methods: Patients were screened for presence of ARDS. Unbiased clus- Acute respiratory distress syndrome with no risk factor of the ter analysis of plasma concentrations of 20 biomarkers of inflammation, berlin definition: an ancillary analysis of the LUNG SAFE study coagulation and endothelial activation at diagnosis of ARDS provided N. de Prost1,2, T. Pham3,4,5, G. Carteaux1,2, A. Mekontso Dessap1,2,C. the endophenotypes. A decision tree was then used to predict cluster Brun-Buisson1,2, E. Fan6, G. Bellani7, J. Laffey8, A. Mercat9, L. Brochard10, membership based on a more restricted set of biomarkers. The inde- B. Maitre1,2, LUNG SAFE investigators and the ESICM study group pendent association of endophenotypes with ICU mortality was studied 1CHU Henri Mondor, Medical ICU, Créteil, France; 2Université de Paris by multivariate logistic regression. Est-Créteil, Groupe de Recherche Clinique CARMAS, Créteil, France; 3Hôpital Results: Three endophenotypes of ARDS were identified in 771 pa- Tenon, APHP, Medical and Surgical ICU, Paris, France; 4Université Paris tients, which we named 'impassive' (N = 383), 'intermediate' (N = 224) Diderot, Sorbonne Paris Cité, UMR 1153, Paris, France; 5University of Toronto, and 'reactive' (N = 164), had mortality rates of 16 %, 26 % and 47 %, Interdepartmental Division of Critical Care, Toronto, Canada; 6University respectively (P < 0.01). Patients with a 'reactive' endophenotype were Health Network, University of Toronto, Critical Care Medicine, Toronto, younger, had higher disease severity scores, more failing organs and Canada; 7University of Milan - Bicocca, Health Sciences, School of Medicine more frequently had an indirect cause for ARDS than patients with and Surgery, Monza, Italy; 8St Michael's Hospital, University of Toronto, an 'impassive' or 'intermediate' endophenotype. A 'reactive endophe- Anesthesia, Toronto, Canada; 9CHU d'Angers, Medical ICU, Angers, France; notype' was independent from confounders associated with ICU 10University of Toronto Saint Michael's Hospital and Keenan Research mortality (OR 1.18 [95 % confidence interval: 1.09-1.28]). The concen- Centre, Interdepartmental Division of Critical Care, Toronto, Canada tration of interleukin 10, interleukin 8 and matrix metalloproteinase 8 Correspondence: T. Pham – Hôpital Tenon, APHP, Medical and Surgical were sufficient to predict the three endophenotypes. ICU, Paris, France Conclusions: ARDS patients can be clustered into three biological Intensive Care Medicine Experimental 2016, 4(Suppl 1):A2 endophenotypes, with different mortality rates. Three easy to measure biomarkers can be used to predict the endophenotype. Introduction: Patients meeting the Berlin definition criteria for the acute respiratory distress syndrome (ARDS) might lack exposure to References one or more “common” risk factors. Such patients might exhibit dif- 1. Takeda S. Pulm Pharmacol Ther 2005. ferent clinical phenotype and outcomes than others and constitute 2. Boyle AJ. Expert Opin Biol Ther 2014. an individualized subgroup of patients. 3. Cepkova M. J Intensive Care Med 2006. Objectives: To compare the clinical presentation and outcome of pa- 4. Calfee CS. Chest 2007. tients having ARDS with vs without risk factors, to determine whether 5. Beitler JR. Chest 2014. the lack of ARDS risk factor is associated with hospital mortality, and © 2016 The Author(s). Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Intensive Care Medicine Experimental 2016, 4(Suppl 1):27 Page 2 of 607 to identify factors associated with hospital mortality in the subgroup A3 of ARDS patients with no risk factors. The consequences of the acute respiratory distress syndrome in Methods: Ancillary study of an international, multicenter, prospective patients undergoing oesophagectomy cohort study (LUNG SAFE study[1]). Patients meeting ARDS criteria P.A. Howells1, D.R. Thickett1, C. Knox2, D.P. Park3, F. Gao1,3, O. Tucker4,T. (Berlin definition) on day 1 or 2 of acute hypoxemic respiratory fail- Whitehouse5, D.F. McAuley6,7, G.D. Perkins3,8 ure onset were included in the study and categorized as having 1University of Birmingham, Institute for Inflammation and Ageing, “common” risk factors or not. Birmingham, United Kingdom; 2University of Sheffield, Mathematics and Results: Among the 2813 patients presenting ARDS in the first 48 h, Statistics Help Centre, Sheffield, United Kingdom; 3Heart of England NHS 266 patients (9.4 %) had no ARDS risk factor identified at admission. Foundation Trust, Intensive Care Medicine, Birmingham, United Table 2 shows the final ARDS risk factor identified in patients with or Kingdom; 4University Hospitals Birmingham NHS Trust, Department of without initial risk factor identified. Surgery, Birmingham, United Kingdom; 5University Hospitals Birmingham The patients with no risk factor were older, had more frequent previ- NHS Trust, Anaesthesia and Critical Care Medicine, Birmingham, United ously known chronic diseases and presented with less severe SOFA Kingdom; 6Queen's University of Belfast, Wellcome-Wolfson Institute for (8.7 ± 3.9 vs 9.5 ± 4.1, p < 0.001) and non-pulmonary (5.4 ± 3.9 vs 6.3 Experimental Medicine, Belfast, United Kingdom; 7Royal Victoria Hospital, ± 4.1, p < 0.001) SOFA scores. ICU mortality was lower in ARDS pa- Intensive Care Medicine, Belfast, United Kingdom; 8University of Warwick, tients with no risk factor than in others (28.6 % vs 34.9 %, p = 0.047), Warwick Clinical Trials Unit, Coventry, United Kingdom but in-hospital mortality was not (35.7 % vs 39.8 %, p = 0.20). The lack Correspondence: P.A. Howells – University of Birmingham, Institute for of ARDS risk factor was not associated with hospital mortality (ad- Inflammation and Ageing, Birmingham, United Kingdom justed OR = 0.86 [0.65-1.13], p = 0.29). In the subgroup of patients Intensive Care Medicine Experimental 2016, 4(Suppl 1):A3 with no ARDS risk factor, age, SOFA, concomitant heart failure, and administration of steroids within 72 hours of ARDS onset were associ- Introduction: The Acute Respiratory Distress Syndrome (ARDS) is a ated with hospital mortality (Table 3). serious complication following major surgery1. ARDS frequently com- Conclusions: Almost ten percent of patients with ARDS had no risk plicates oesophagectomy. The Beta Agonist Lung Injury Prevention factor identified and exhibit a different clinical phenotype than Trial (BALTI-P)2 provided a large cohort of patients having undergone others. Future research aimed at studying management strategies in oesophagectomy who had been systematically screened for ARDS. this subgroup of patients is warranted. Objectives: To characterise patients developing ARDS following oeso- phagectomy and identify risk factors for ARDS in this group. References Methods: Data were collected as part of the BALTI-P trial, which in- [1] Bellani G, et al. JAMA. 2016 Feb 23;315(8):788800 cluded daily assessment of oxygenation. Chest x-rays were assessed Trial Registration: ClinicalTrials.gov NCT02010073 by an expert panel. A comparison of Early ARDS (first post-operative 72 hours) and Late ARDS (after 72 hours) was undertaken using uni- Grant acknowledgement variate and multivariate analysis. Differences in outcome were deter- The LUNG SAFE study was supported by the ESICM.
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