SPIRES Scoring Model Stratifies Acute Respiratory Distress Syndrome Into Risk Categories

ARDS diagnosis
ARDS diagnosis
A novel scoring system developed by SIESTA, a Spanish research network, aids in management and prognosis of acute respiratory distress syndrome.

A novel scoring model, the Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome (SPIRES) score, is a potential strategy for the early stratification of acute respiratory distress syndrome (ARDS) into different management categories, according to study results published in Critical Care Medicine.

A team of investigators for the Spanish Initiative for Epidemiology, Stratification and Therapies of ARDS (SIESTA) Network conducted a development and validation study (ClinicalTrials.gov Identifiers: NCT00736892, NCT02288949, NCT02836444, NCT03145974) using clinical data from 4 prospective, multicenter, observational cohorts to determine whether using clinical variables to assess heterogeneity and probability of outcomes of interest could accurately cluster patients with ARDS into risk categories.

The researchers hypothesized that distinct prognostic classes of ARDS could be stratified and identified using an ARDS score, which could help in selecting eligible patients with ARDS for randomized clinical trials. The SPIRES score was based on the patient’s age, the number of extrapulmonary organ failures, values of end-inspiratory plateau pressure, and the ratio of arterial oxygen partial pressure (PaO2) to fractional inspired oxygen (FiO2) at 24 hours of ARDS diagnosis.

The analysis was performed in 3 steps, the first 2 of which included 1000 patients with moderate to severe ARDS in a secondary analysis of model development and internal-external validation. The third step tested the model performance in a new group of 301 patients with moderate to severe ARDS who were admitted to intensive care units (ICUs) from May 2017 to March 2018. The primary outcome was ICU death.

The first portion of the study using internal-external validation resulted in a pooled area under the receiver operating characteristic curve of 0.860. The third portion of the study revealed the accuracy and robustness of the scoring model with an area under the receiver operating characteristic curve of 0.870.

The SPIRES score was able to stratify patients into 3 distinct prognostic classes and individual SPIRES scores predicted ICU death better than either PaO2/FiO2 ratio at onset or at 24 hours of ARDS diagnosis, the Acute Physiology and Chronic Health Evaluation II score, or the Sequential Organ Failure Assessment scale.

“The SPIRES score can be used to stratify patients into different prognostic (probably, management) categories,” the authors noted. “This score should be further validated to determine its applicability in other countries,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Villar J, González-Martín JM, Ambrós A, et al for the Spanish Initiative for Epidemiology, Stratification and Therapies of ARDS (SIESTA) Network. Stratification for identification of prognostic categories in the Acute RESpiratory Distress Syndrome (SPIRES) Score. Crit Care Med. Published online July 2, 2021. doi:10.1097/CCM.0000000000005142