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doi: 10.1097/ALN.0000000000000216
Critical Care Medicine: Clinical Science

Predicting Risk of Postoperative Lung Injury in High-risk Surgical Patients: A Multicenter Cohort Study

Kor, Daryl J. M.D.; Lingineni, Ravi K. M.P.H.; Gajic, Ognjen M.D., M.Sc.; Park, Pauline K. M.D.; Blum, James M. M.D.; Hou, Peter C. M.D.; Hoth, J. Jason M.D.; Anderson, Harry L. III M.D.; Bajwa, Ednan K. M.D., M.P.H.; Bartz, Raquel R. M.D.; Adesanya, Adebola M.D.; Festic, Emir M.D.; Gong, Michelle N. M.D., M.S.; Carter, Rickey E. Ph.D.; Talmor, Daniel S. M.D., M.P.H.

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Background: Acute respiratory distress syndrome (ARDS) remains a serious postoperative complication. Although ARDS prevention is a priority, the inability to identify patients at risk for ARDS remains a barrier to progress. The authors tested and refined the previously reported surgical lung injury prediction (SLIP) model in a multicenter cohort of at-risk surgical patients.
Methods: This is a secondary analysis of a multicenter, prospective cohort investigation evaluating high-risk patients undergoing surgery. Preoperative ARDS risk factors and risk modifiers were evaluated for inclusion in a parsimonious risk-prediction model. Multiple imputation and domain analysis were used to facilitate development of a refined model, designated SLIP-2. Area under the receiver operating characteristic curve and the Hosmer–Lemeshow goodness-of-fit test were used to assess model performance.
Results: Among 1,562 at-risk patients, ARDS developed in 117 (7.5%). Nine independent predictors of ARDS were identified: sepsis, high-risk aortic vascular surgery, high-risk cardiac surgery, emergency surgery, cirrhosis, admission location other than home, increased respiratory rate (20 to 29 and ≥30 breaths/min), FIO2 greater than 35%, and SpO2 less than 95%. The original SLIP score performed poorly in this heterogeneous cohort with baseline risk factors for ARDS (area under the receiver operating characteristic curve [95% CI], 0.56 [0.50 to 0.62]). In contrast, SLIP-2 score performed well (area under the receiver operating characteristic curve [95% CI], 0.84 [0.81 to 0.88]). Internal validation indicated similar discrimination, with an area under the receiver operating characteristic curve of 0.84.
Conclusions: In this multicenter cohort of patients at risk for ARDS, the SLIP-2 score outperformed the original SLIP score. If validated in an independent sample, this tool may help identify surgical patients at high risk for ARDS.

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