An alternative method of acute lung injury classification for use in observational studies

Chirag V. Shah, Paul N. Lanken, A. Russell Localio, Robert Gallop, Scarlett Bellamy, Shwu Fan Ma, Carlos Flores, Jeremy M. Kahn, Barbara Finkel, Barry D. Fuchs, Joe G.N. Garcia, Jason D. Christie

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Background: In observational studies using acute lung injury (ALI) as an outcome, a spectrum of lung injury and difficult-to-interpret chest radiographs (CXRs) may hamper efforts to uncover risk factor associations. We assessed the impact of excluding patients with difficult-to-classify or equivocal ALI diagnosis on clinical and genetic risk factor associations for ALI after trauma. Methods: This study was of a prospective cohort of 280 critically ill trauma patients. The primary outcome was the development of ALI. Patients were classified into one of three groups:(1) definite ALI (patients who fulfilled the American-European Consensus Conference [AECC] criteria for ALI), (2) equivocal ALI (patients who had difficult-to-interpret CXRs), and (3) definite non-ALI. We compared clinical and genetic ALI risk factor associations between two classification schemes: AECC classification (definite ALI vs rest) and alternative classification (definite ALI vs definite non-ALI, excluding equivocal ALI). Results: Ninety-three (35%) patients were classified as definite ALI, 67 (25%) as equivocal, and 104 (39%) as definite non-ALI. Estimates of clinical and genetic ALI risk factor associations were farther from the null using the alternative classification. In a multivariable risk factor model, the C statistic of the alternative classification was significantly higher than that derived from the AECC classification (0.82 vs 0.74; P < .01). Conclusions: The ability to detect ALI risk factors may be improved by excluding patients with equivocal or difficult-to-classify ALI. Such analyses may provide improved ability to detect clinical and genetic risk factor associations in future epidemiologic studies of ALI.

Original languageEnglish (US)
Pages (from-to)1054-1061
Number of pages8
JournalCHEST
Volume138
Issue number5
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Shah, C. V., Lanken, P. N., Localio, A. R., Gallop, R., Bellamy, S., Ma, S. F., Flores, C., Kahn, J. M., Finkel, B., Fuchs, B. D., Garcia, J. G. N., & Christie, J. D. (2010). An alternative method of acute lung injury classification for use in observational studies. CHEST, 138(5), 1054-1061. https://doi.org/10.1378/chest.09-2697