Nonpulmonary risk factors of acute respiratory distress syndrome in patients with septic bacteraemia
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Background/Aims: The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied. Methods: We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016. Results: The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality. Conclusions: Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.
Abstract
Background/Aims: The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied. Methods: We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016. Results: The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality. Conclusions: Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.
참고문헌 (23)
- "National inpatient hospital costs: the most expensive conditions by payer, 2011. Statistical Brief #160. In: United States. Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs" (2006)[URL]
- Seethala RR, "Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients", Ann Intensive Care, 7, pp.11~ (2017)
- Ferguson ND, "Clinical risk conditions for acute lung injury in the intensive care unit and hospital ward : a prospective observational study", Crit Care, 11, pp.R96~ (2007)
- Del Sorbo L, "Acute respiratory distress syndrome and multiple organ failure", Curr Opin Crit Care, 17, pp.1~6 (2011)
- Russell JA, "Changing pattern of organ dysfunction in early human sepsis is related to mortality", Crit Care Med, 28, pp.3405~3411 (2000)
- Eggimann P, "Acute respiratory distress syndrome after bacteremic sepsis does not increase mortality", Am J Respir Crit Care Med, 167, pp.1210~1214 (2003)
- Mikkelsen ME, "The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis", Shock, 40, pp.375~381 (2013)
- Shankar-Hari M, "Developing a new definition and assessing new clinical criteria for septic shock : for the third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.775~787 (2016)
- Singer M, "The third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.801~810 (2016)
- Dellinger RP, "Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock : 2012", Crit Care Med, 41, pp.580~637 (2013)
- Dellinger RP, "Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock : 2008", Intensive Care Med, 34, pp.17~60 (2008)
- ARDS Definition Task Force, "Acute respiratory distress syndrome : the Berlin Definition", JAMA, 307, pp.2526~2533 (2012)
- American College of Chest Physicians, "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis", Crit Care Med, 20, pp.864~874 (1992)
- Levy MM, "SCCM", ESICM, ATS, pp.SIS international sepsis definitions conference, Intensive Care Med[DOI]
- Seymour CW, "Assessment of clinical criteria for sepsis : for the third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.762~774 (2016)
- Moss M, "Chronic alcohol abuse is associated with an increased incidence of acute respiratory distress syndrome and severity of multiple organ dysfunction in patients with septic shock", Crit Care Med, 31, pp.869~877 (2003)
- Gattinoni L, "Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease", Different syndromes? Am J Respir Crit Care Med, 158, pp.3~11 (1998)
- Frantzeskaki F, "Immunothrombosis in acute respiratory distress syndrome : cross talks between inflammation and coagulation", Respiration, 93, pp.212~225 (2017)
- Miyashita T, "A three-phase approach for the early identification of acute lung injury induced by severe sepsis", In Vivo, 30, pp.341~349 (2016)
- Xue M, "Diagnostic and prognostic utility of tissue factor for severe sepsis and sepsis-induced acute lung injury", J Transl Med, 13, pp.172~ (2015)
- Moss M, "The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults", JAMA, 275, pp.50~54 (1996)
- Sevransky JE, "Pulmonary vs nonpulmonary sepsis and mortality in acute lung injury", Chest, 134, pp.534~538 (2008)
- Sheu CC, "The influence of infection sites on development and mortality of ARDS", Intensive Care Med, 36, pp.963~970 (2010)