suppression were the only independent predictors
of progression to ALI. A pragmatic 3-component
EALI score ( 1 point for an oxygen requirement
> 2–6 L/min or 2 points for > 6 L/min; and 1 point
each for a respiratory rate >30/min and immune
suppression) accurately identified patients who
progressed to ARDS. In this higher-risk cohort, an
EALI score of 2 or greater identified patients who
progressed to ARDS with 89% sensitivity and 75%
specificity, and corresponded to positive and negative predictive values of 53% and 95%.
The EALI and LIPS scores highlight important
aspects of designing strategies for identification
of patients at risk for developing ARDS. The EALI
score was derived in patients with at least some
evidence of early bilateral opacities on chest radiograph. This requirement increased the baseline
incidence of developing ARDS to 25% compared
to 7% in the LIPS cohort, but also likely limits the
utility for identifying patients, particularly high-risk
surgical patients, who may progress rapidly without an interval qualifying chest radiograph. While
the LIPS may provide a longer time window to
identify patients and initiate preventative strategies,
some interventions may require targeting higher-risk populations with evidence of early but existing
lung injury. Selection of criteria to identify appropriate target populations will largely depend on the
nature of the intervention. For strategies targeting
prevention of exposure to modifiable risk factors,
sensitive criteria generalizable to multiple patient
populations like the LIPS may be ideal. However,
clinical trials testing novel treatments may need to
target higher-risk patients with existing physiologic
and radiographic surrogate endpoints of lung
injury.
The paradigm shift toward prevention and early
treatment of acute lung injury is now a major focus
of the National Institutes of Health through forma-
tion of the PETAL Network. Hopefully, continued
organized efforts to develop effective strategies to
identify high-risk patients and prevent exposure to
secondary risk factors for lung injury, as well as
novel therapies for the treatment of early acute
lung injury, will further reduce the still consider-
Table 4. Lung Injury Prediction Score (LIPS)
LIPS Points
Predisposing conditions
Shock 2
Aspiration 2
Sepsis 1
Pneumonia 1. 5
High-risk surgery 1. 5 (if emergent)
Orthopedic spine 1
Acute abdomen 2
Cardiac 2. 5
Aortic vascular 3. 5
High-risk trauma
Traumatic brain injury 2
Smoke inhalation 2
Near drowning 2
Lung contusion 1. 5
Multiple fractures 1. 5
Risk modifiers
Alcohol abuse 1
Obesity (BMI >30) 1
Hypoalbuminemia 1
Chemotherapy 1
FIO2 >35% (> 4 L/min) 2
Tachypnea (RR >30 bpm) 1. 5
SpO2 <95% 1
Acidosis (pH < 7.35) 1. 5
Diabetes (only if with sepsis) – 1
BMI = body mass index; FIO2 = fraction of inspired oxygen; RR =
respiratory rate; bpm = breaths per minute; SpO2 = arterial oxygen
saturation.
Adapted with permisson from Gajic O, Dabbagh O, Park PK, et al.
Early identification of patients at risk of acute lung injury: evaluation of
lung injury prediction score in a multicenter cohort study. Am J Resp
Crit Care Med 2011;183:462–70.
