ESICM LIVES 2016: part one

to identify factors associated with hospital mortality in the subgroup of ARDS patients with no risk factors. Methods: Ancillary study of an international, multicenter, prospective cohort study (LUNG SAFE study[1]). Patients meeting ARDS criteria (Berlin definition) on day 1 or 2 of acute hypoxemic respiratory failure onset were included in the study and categorized as having "common" risk factors or not. Results: Among the 2813 patients presenting ARDS in the first 48 h, 266 patients (9.4 %) had no ARDS risk factor identified at admission. Table The patients with no risk factor were older, had more frequent previously known chronic diseases and presented with less severe SOFA (8.7 3.9 vs 9.5 4.1, p < 0.001) and non-pulmonary (5.4 3.9 vs 6.3 4.1, p < 0.001) SOFA scores. ICU mortality was lower in ARDS patients with no risk factor than in others (28.6 % vs 34.9 %, p = 0.047), but in-hospital mortality was not (35.7 % vs 39.8 %, p = 0.20). The lack of ARDS risk factor was not associated with hospital mortality (adjusted OR = 0.86 [0.65-1.13], p = 0.29). In the subgroup of patients with no ARDS risk factor, age, SOFA, concomitant heart failure, and administration of steroids within 72 hours of ARDS onset were associated with hospital mortality (Table Conclusions: Almost ten percent of patients with ARDS had no risk factor identified and exhibit a different clinical phenotype than others. Future research aimed at studying management strategies in this subgroup of patients is warranted.

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