Early Predictors of Survival in Acute Respiratory Distress Syndrome

doctor holding an xray
Changes in Radiographic Assessment of Lung Edema (RALE) scores in patients with ARDS were independently associated with survival.

Changes in Radiographic Assessment of Lung Edema (RALE) scores in patients with acute respiratory distress syndrome (ARDS) were independently associated with survival, according to the study results published in CHEST.

RALE scores at day 0 (baseline) and days 2 to 3 from patients with ARDS were retrospectively analyzed. Survival rates at day 90 were then compared between groups of patients who exhibited early changes in RALE scores and those who did not to determine whether RALE changes may be predictive of survival rates.

Of the 135 patients with chest radiographs available on day 0, a total of 64 patients had data available for day 2 and 88 patients had data available on day 3. Of these 135 patients, 46 patients had died by day 90, while 89 had survived. In the primary study outcome, both baseline RALE and the change in RALE scores over time were independently associated with death at day 90. The results were confirmed even after adjustment for age, sex, body mass index, Simplified Acute Physiology Score II, need for vasopressor use at baseline, and total volume of fluids received at study entry.

“In this analysis, we found that changes in RALE over the first three days of ARDS were independently associated with 90-day survival in ARDS, even after multivariable adjustment for the baseline RALE score and other risk stratifiers,” the study authors wrote.


Jabaudon M, Audard J, Pereira B, et al. Early changes over time in the Radiographic Assessment of Lung Edema (RALE) score are associated with survival in acute respiratory distress syndrome [published online July 10, 2020]. CHEST. doi:10.1016/j.chest.2020.06.070