Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the "Validating Acute Lung Injury Biomarkers for Diagnosis" Study.
10 affiliations
- 1Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
- 2Division of Intensive Care, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-j), University of Bari "Aldo Moro," Bari, Italy.
- 3Department of Perioperative Medicine, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Clermont-Ferrand, France.
- 4iGReD, CNRS, INSERM, Université Clermont Auvergne, Clermont-Ferrand, France.
- 5Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
- 6Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
- 7Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
- 8Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, Vienna, Austria.
- 9Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
- 10Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
Abstract
Objectives
To determine the diagnostic accuracy of the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS) and its interobserver reliability.Design
Post hoc analysis of a prospective observational cohort study.Setting
ICUs at Vanderbilt University Medical Center participating in the Validating Acute Lung Injury Biomarkers for Diagnosis study.Patients
Adult patients receiving invasive ventilation for at least two consecutive days, with chest radiographs available on the first 2 ICU days.Interventions
None.Measurements and main results
Chest radiographs from the first 2 ICU days were scored independently by at least two experienced raters; scores were averaged per radiograph, and the highest averaged score from ICU day 1 or 2 was selected for analysis. The primary outcome was ARDS according to the Berlin definition during the first 2 ICU days. Of 236 patients, 92 (39%) had ARDS. The median RALE score was higher in patients with ARDS than in those without (29.5 [22.2-34.5] vs. 12.2 [7.5-17.8]; p < 0.01). The area under the receiver operating characteristic curve was 0.93 (95% CI, 0.90-0.96). At the optimal cutoff of 20, sensitivity was 85%, specificity 83%, positive predictive value 76%, and negative predictive value 90%. Interobserver reliability was high, with pairwise intraclass correlation coefficients ranging from 0.81 to 0.87.Conclusions
In patients invasively ventilated for at least 2 days, the RALE score demonstrated excellent diagnostic accuracy for ARDS at a cutoff of 20, together with high interobserver reliability, supporting its potential role as a standardized radiographic tool in the diagnosis of ARDS.
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BibTeX
@article{zimatore2026diagnostic,
title = {{Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the "Validating Acute Lung Injury Biomarkers for Diagnosis" Study.}},
author = {Claudio Zimatore and Matthieu Jabaudon and Luigi Pisani and Tatsuki Koyama and Marcus J Schultz and Lorraine B Ware},
journal = {Critical care explorations},
year = {2026},
month = oct,
doi = {10.1097/cce.0000000000001495},
url = {https://europepmc.org/article/MED/42902574},
note = {CC BY},
}
RIS
TY - JOUR
TI - Diagnostic Performance of the Radiographic Assessment of Lung Edema Score for Acute Respiratory Distress Syndrome-Post Hoc Analysis of the "Validating Acute Lung Injury Biomarkers for Diagnosis" Study.
AU - Claudio Zimatore
AU - Matthieu Jabaudon
AU - Luigi Pisani
AU - Tatsuki Koyama
AU - Marcus J Schultz
AU - Lorraine B Ware
PY - 2026
DA - 2026/10/21
JO - Critical care explorations
DO - 10.1097/cce.0000000000001495
UR - https://europepmc.org/article/MED/42902574
AB - Objectives To determine the diagnostic accuracy of the Radiographic Assessment of Lung Edema (RALE) score for acute respiratory distress syndrome (ARDS) and its interobserver reliability.Design Post hoc analysis of a prospective observational cohort study.Setting ICUs at Vanderbilt University Medical Center participating in the Validating Acute Lung Injury Biomarkers for Diagnosis study.Patients Adult patients receiving invasive ventilation for at least two consecutive days, with chest radiographs available on the first 2 ICU days.Interventions None.Measurements and main results Chest radiographs from the first 2 ICU days were scored independently by at least two experienced raters; scores were averaged per radiograph, and the highest averaged score from ICU day 1 or 2 was selected for analysis. The primary outcome was ARDS according to the Berlin definition during the first 2 ICU days. Of 236 patients, 92 (39%) had ARDS. The median RALE score was higher in patients with ARDS than in those without (29.5 [22.2-34.5] vs. 12.2 [7.5-17.8]; p < 0.01). The area under the receiver operating characteristic curve was 0.93 (95% CI, 0.90-0.96). At the optimal cutoff of 20, sensitivity was 85%, specificity 83%, positive predictive value 76%, and negative predictive value 90%. Interobserver reliability was high, with pairwise intraclass correlation coefficients ranging from 0.81 to 0.87.Conclusions In patients invasively ventilated for at least 2 days, the RALE score demonstrated excellent diagnostic accuracy for ARDS at a cutoff of 20, together with high interobserver reliability, supporting its potential role as a standardized radiographic tool in the diagnosis of ARDS.
SN - 2639-8028
ER -