Mortality in sepsis versus non-sepsis induced acute lung injury

• Type of Material: Article
• Authors: Jonathan Servansky, Johns Hopkins University; Greg Martin, Emory University; Carl Shanholtz, University of Maryland; Pedro A. Mendez-Tellez, Johns Hopkins University; Peter Pronovost, Johns Hopkins University; Roy Brower, Johns Hopkins University; Dale M. Needham, Johns Hopkins University
• Language: English
• Date: 2009-09-16
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2009 Sevransky et al; licensee BioMed Central Ltd.
• License: Creative Commons Attribution 2.0 Generic
• Final Published Version (URL): http://ccforum.com/content/13/5/R150
• Title of Journal or Parent Work: Critical Care
• ISSN: 1364-8535
• Volume: 13
• Issue: 5
• Start Page: 1
• End Page: 6
• Grant/Funding Information: JES is supported by K-23 GMO7-1399-01A1.; DMN is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research (CIHR).; This research was supported by a NHBLI SCCOR grant in Acute Lung Injury SCCOR grant P050 HL 73994.
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

Introduction Sepsis-induced acute lung injury (ALI) has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding. Methods 520 patients enrolled in the Improving Care of ALI Patients Study (ICAP) were prospectively characterized as having sepsis or non sepsis-induced ALI. Biologically plausible risk factors for in-hospital death were considered in multiple logistic regression models to evaluate the independent association of sepsis vs. non-sepsis ALI risk factors with mortality. Results Patients with sepsis-induced ALI had greater illness severity and organ dysfunction (APACHE II and SOFA scores) at ALI diagnosis and higher crude in-hospital mortality rates compared with non-sepsis ALI patients. Patients with sepsis-induced ALI received similar tidal volumes, but higher levels of positive end expiratory pressure, and had a more positive net fluid balance in the first week after ALI diagnosis. In multivariable analysis, the following variables (odds ratio, 95% confidence interval) were significantly associated with hospital mortality: age (1.04, 1.02 to 1.05), admission to a medical intensive care unit (ICU) (2.76, 1.42 to 5.36), ICU length of stay prior to ALI diagnosis (1.15, 1.03 to 1.29), APACHE II (1.05, 1.02 to 1.08), SOFA at ALI diagnosis (1.17, 1.09 to 1.25), Lung Injury Score (2.33, 1.74 to 3.12) and net fluid balance in liters in the first week after ALI diagnosis (1.06, 1.03 to 1.09). Sepsis did not have a significant, independent association with mortality (1.02, 0.59 to 1.76). Conclusions Greater severity of illness contributes to the higher case fatality rate observed in sepsis-induced ALI. Sepsis was not independently associated with mortality in our study.