Study on the clinicopathological correlation in the secondary acute respiratory distress syndrome

Sarmiento, X.; Almirall, J.; Guardiola, J.J.; Mesalles, E.; Labarta, L.; Mate, J.L.; Soler, M.; Klamburg, J.

doi:10.1016/S2173-5727(11)70005-4

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Abstract

Objective

This study has aimed to study the clinicopathological correlation of patients with secondary acute respiratory distress syndrome (ARDS), specifically having extrapulmonary causes.

Setting

A 22 beds intensive care unit.

Design

An observational study of case series.

Patients

Seventeen patients whose death was caused by acute respiratory distress syndrome were included.

Intervention

A systematic histopathological study was made of all the pulmonary lobes of patients who died in our ICU with the clinical diagnosis of secondary ARDS, who had undergone an autopsy between 1999 and 2009. The Kappa analysis was used to analyze the grade of correlation between the clinical and the pathological diagnosis.

Results

The autopsy confirmed to cases of false positive in 17 patients with ARDS (11%). The kappa value was 0.77, so that the concordance analysis was considered to be satisfactory.

Conclusions

The clinical criteria for ARDS correlate well with acute alveolar damage (AAD) in the autopsy study in patients with secondary ARDS, although some false positive cases can be observed.

Keywords:

Respiratory failure

Acute respiratory distress syndrome

Diffuse alveolar damage

Kappa test

Necropsy

Clinical-pathological study

Acute lung injury

Resumen

Objetivo

El objetivo principal del estudio es analizar la correlación clinicopatológica en el diagnóstico de síndrome de distrés respiratorio agudo (SDRA) de origen extrapulmonar.

Diseño

Se trata de un estudio observacional de una serie de casos.

Ámbito

UCI de 22 camas de un hospital universitario con 450 camas.

Pacientes

Diecisiete pacientes fallecidos a causa de un SDRA secundario.

Intervención

Análisis histopatológico sistemático de todos los lóbulos pulmonares de pacientes que fallecieron en nuestra UCI con el diagnóstico clínico de SDRA secundario y en los que se realizó necropsia entre los años 1999 y 2009. A fin de analizar el grado de correlación entre el diagnóstico clínico y el patológico se aplicó el análisis de kappa.

Resultados

En 17 pacientes con SDRA secundario la necropsia permitió confirmar 2 casos falsos positivos (11%). El valor kappa fue de 0,77, por lo que el análisis de concordancia fue considerado como satisfactorio.

Conclusiones

Los criterios clínicos para el diagnóstico de SDRA se correlacionan bien con la presencia de daño alveolar agudo en el estudio patológico necrópsico en pacientes con SDRA secundario, aunque pueden detectarse algunos casos falsos positivos.

Palabras clave:

Insuficiencia respiratoria

Síndrome de distrés respiratorio agudo

Daño alveolar difuso

Análisis de kappa

Necropsia

Estudio clinicopatológico

Lesión pulmonar aguda

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