Villar et al reported the APPS (Age, PaO2 to FIO2 ratio, plateau pressure score) in patients with the adult respiratory distress syndrome (ARDS). This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Spain and Boston and they are members of the Stratification and Outcome of Acute Respiratory Distress Syndrome (STANDARDS) Network.
The authors think of the score as comparable to the Apgar score.
Patient selection: adult with ARDS
Parameters:
(1) age of the patient in years
(2) PaO2 to FIO2 ratio (PaO2 in mm Hg)
(3) plateau pressure in cm H2O
Parameter
Finding
Points
age in years
< 47 years
1
47 to 66 years
2
> 66 years
3
PaO2 to FIO2 ratio
> 158
1
105 to 158
2
< 105
3
plateau pressure
< 27
1
27 to 30
2
> 30
3
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 9
• The higher the score the worse the 60 day survival.
Score
Risk Group
60 Day Survival
3 or 4
low
81%
5 to 7
intermediate
51%
8 or 9
high
13%
Performance:
• The area under the ROC curve was 0.76 in the derivation cohort and 0.80 for the validation cohort.
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