The effect of acute respiratory distress syndrome on long-term survival

Despite a great deal of information about the risk factors, prognostic vari ables, and hospital mortality in the acute respiratory distress syndrome (A RDS), very little is known about the long-term outcomes of patients with th is syndrome. We conducted a prospective, matched, parallel cohort study wit h the goals of describing the survival of patients with ARDS after hospital discharge and comparing the long-term survival of patients with ARDS and t hat of a group of matched controls. The study involved 127 patients with AR DS associated with trauma or sepsis and 127 controls matched for risk facto r (trauma or sepsis) and severity of illness who survived to hospital disch arge. Time until death was used as the outcome measure. Survival was associ ated with age, risk factor for ARDS, and comorbidity. There was no differen ce in the long-term mortality rate for ARDS patients and that of matched co ntrols (hazard ratio for ARDS: 1.00; 95% confidence interval: 0.47 to 2.09) after controlling for age, risk factor for ARDS, comorbidity, and severity of illness. We conclude that if sepsis or trauma patients survive to hospi tal discharge, ARDS does not increase their risk of subsequent death. Older patients, patients with sepsis, and patients with comorbidities, regardles s of the presence of ARDS, have a higher risk of death after hospital disch arge. For the purposes of clinical prognosis and cost-effectiveness analysi s, the long-term survival of patients with ARDS can be modeled on the basis of age, underlying risk factor for ARDS, and comorbidity.