RT info:eu-repo/semantics/doctoralThesis
T1 Síndrome de distrés respiratorio agudo en el siglo XXI: impacto de la sepsis postoperatoria y tendencias epidemiológicas en España
A1 Bardají Carrillo, Miguel
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Distrés respiratorio
K1 ARDS
K1 SDRA
K1 Distress
K1 Distrés
K1 Sepsis
K1 Epidemiology
K1 Epidemiología
K1 32 Ciencias Médicas
AB INTRODUCTIONAcute respiratory distress syndrome (ARDS) is a complication with high prevalence, mortality, and associated costs. Postoperative sepsis could be a frequent cause, yet there is limited evidence on ARDS induced by it. Its diagnosis is complex, with high interobserver variability in chest radiography interpretation.The epidemiology of ARDS high variability in incidence, mortality rates and associated costs. There is little literature on the impact of the COVID-19 pandemic and on the differences between medical and postoperative ARDS.OBJECTIVES(i) To evaluate 60-day mortality in patients with ARDS due to postoperative sepsis and identify risk factors.(ii) To compare the clinical characteristics of patients with chest radiographs suggestive of ARDS who truly have ARDS versus those who do not.(iii) To analyze trends in ARDS incidence, mortality, and costs in Spain, including the impact of COVID-19.(iv) To compare the prevalence, mortality, and costs of postoperative ARDS versus medical ARDS.MATERIALS AND METHODSFor the first two objectives, a cohort of 454 patients with postoperative sepsis was analyzed, stratified into ARDS and non-ARDS groups according to the Berlin criteria. Chest radiographs were evaluated, and a multivariate logistic regression analysis was performed.For the last two objectives, a retrospective study was conducted, including 93,192 patients diagnosed with ARDS in Spanish hospitals (2000–2022). Data were obtained from the MBDS, and a multivariate Poisson regression analysis was used to assess trends in incidence, mortality, and costs.RESULTSHigher SOFA scores (OR 1.1, p = 0.020) and elevated lactate levels (OR 1.9, p = 0.004) were associated with ARDS development. The 60-day mortality rate was higher in patients with ARDS (OR 2.7, p = 0.024).Of 139 patients (30.6%) with chest radiographs suggestive of ARDS, only 45 (9.9%) were confirmed cases. Urgent surgery (OR 6.6, p < 0.001), abdominal infection (OR 6.0, p = 0.004), pneumonia (OR 8.2, p = 0.001), and elevated lactate levels (OR 3.9, 95% CI 1.3–11.9, p = 0.015) were clinical features associated with ARDS development.Between 2000 and 2022, ARDS incidence ranged from 2.96 to 20.14 per 100,000 person-years. Mortality fluctuated between 38.0% and 55.0%, showing a decreasing trend, whereas cost per patient increased, stabilizing at ?30,000–40,000. During the COVID-19 pandemic, hospital length of stay increased (p < 0.001), while hospital mortality decreased (p < 0.001).Postoperative ARDS prevalence ranged from 0.05% to 0.22%, accounting for 45–50% of ARDS cases. Hospital mortality decreased in both groups, showing a trend towards convergence. The healthcare costs of postoperative ARDS were 1.5 times higher than those of medical ARDS, associated with a longer hospital stay.CONCLUSIONSPostoperative sepsis-induced ARDS increases 60-day mortality. Risk factors include higher SOFA scores and elevated lactate levels.Patients with postoperative sepsis and chest radiographs suggestive of ARDS should be closely monitored if they present pneumonia, abdominal infection, urgent surgery, or elevated lactate levels.Since 2000, ARDS incidence in Spain has remained stable, hospital mortality has decreased, and the cost per patient has quadrupled.Although postoperative ARDS was initially associated with lower mortality than medical ARDS, recent trends show convergence in mortality rates. Furthermore, postoperative ARDS generates costs 1.5 times higher than medical ARDS
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76243
UL https://uvadoc.uva.es/handle/10324/76243
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 05-jul-2025