AUTHOR=Liu Xiaoqin , Pan Chun , Si Lining , Tong Shijun , Niu Yi , Qiu Haibo , Gan Guifen 

TITLE=Definition of Acute Respiratory Distress Syndrome on the Plateau of Xining, Qinghai: A Verification of the Berlin Definition Altitude-PaO2/FiO2-Corrected Criteria

JOURNAL=Frontiers in Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.648835

DOI=10.3389/fmed.2022.648835

ISSN=2296-858X

ABSTRACT=Background: Acute respiratory distress syndrome (ARDS) is a common critical respiratory illness. Hypoxia at high altitude is a factor influencing the progression of ARDS. Currently, we lack clear diagnostic criteria for high-altitude acute respiratory distress syndrome. The purpose of this study was to determine the value of the application of the Berlin Definition Altitude-PaO2/FiO2-corrected criteria  for ARDS in Xining, Qinghai (2261 m).
Methods: We retrospectively analyzed the clinical data of patients with ARDS admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Qinghai University from January 2018 to December 2018. The severity of ARDS was categorized according to the Berlin definition, Berlin Definition Altitude-PaO2/FiO2-corrected criteria, and the diagnostic criteria for ALI/ARDS at high altitudes in Western China(Zhang criteria), and the differences between the three criteria were compared.
Results: Among 1221 patients, 512 were treated with mechanical ventilation. In addition, 253 met the Berlin definition, including 49 (19.77%) with mild ARDS, 148 (58.50%) with moderate ARDS, and 56 (22.13%) with severe ARDS. A total of 229 patients met the altitude-PaO2/FiO2-corrected criteria, including 107 with mild ARDS (46.72%), 84 with moderate ARDS (36.68%) and 38 (16.59%) with severe ARDS. ICU mortality increased with the severity of ARDS (mild, 17.76%; moderate, 21.43%; and severe, 47.37%). Twenty-eight-day mortality increased with worsening ARDS (mild 23.36% vs. moderate 44.05% vs. severe 63.16%) (P<0.001). There were 204 patients who met the Zhang criteria, including 87 (42.65%) with acute lung injury, and 117 (57.35%) with ARDS. The AUROCs of the Berlin definition, altitude-P/F-corrected and Zhang criteria were 0.6675 (95% CI 0.5866-0.7484), 0.6216 (95% CI 0.5317-0.7116) and 0.6050 (95% CI 0.5084-0.7016), respectively. There was no statistically significant differences between the three diagnostic criteria
Conclusion: For Xining, Qinghai, the altitude-PaO2/FiO2-corrected criteria for ARDS can distinguish the severity of ARDS, but these results need to be confirmed in a larger sample and in multicenter clinical studies.