Clinical Characteristics and Outcomes of Sepsis-Related vs. Non-Sepsis-Related Acute Respiratory Distress Syndrome.
Chest. 2010 May 27;
Authors: Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF, Gallagher DC, Thompson BT, Christiani DC
Abstract BACKGROUND: Acute respiratory distress syndrome (ARDS) may occur after either septic or nonseptic injuries. Sepsis is the major cause of ARDS. However, little is known about the differences between sepsis-related and non-sepsis-related ARDS. METHODS: Consecutive 2786 patients with ARDS predisposing conditions were enrolled into the prospective cohort, of which 736 patients developed ARDS. We defined sepsis-related ARDS as ARDS developing in patients with sepsis, and non-sepsis-related ARDS as ARDS developing after nonseptic injuries such as trauma, aspiration, and multiple transfusions. Patients with both septic and nonseptic risks were excluded from analysis. RESULTS: Compared to non-sepsis-related ARDS patients (n=62), sepsis-related ARDS patients (n=524) were more likely to be female, diabetics, less likely to have preceding surgery, and had longer pre-ICU hospital stays and higher APACHE III scores (median, 78 vs. 65, p<0.0001). There were no differences in lung injury score, blood pH, PaO(2)/FiO(2) ratio, and PaCO(2) on ARDS diagnosis. However, sepsis-related ARDS patients had significantly lower PaO(2)/FiO(2) ratios than non-sepsis-related ARDS patients on ARDS day 3 (p=0.018), day 7 (p=0.004), and day 14 (p=0.004) (repeat measures analysis, p=0.011). Compared with non-sepsis-related ARDS patients, sepsis-related ARDS patients had a higher 60-day mortality (38.2% vs. 22.6%, p=0.016), a lower successful extubation rate (53.6% vs. 72.6%, p=0.005), and fewer ICU-free days (p=0.0001) and ventilator-free days (p=0.003). In multivariate analysis, age, APACHE III score, liver cirrhosis, metastatic cancer, admission serum bilirubin and glucose levels, and treatment with activated protein C were independently associated with 60-day ARDS mortality. After adjustment, sepsis-related ARDS was no longer associated with higher 60-day mortality, (HR, 1.26, 95% CI, 0.71-2.22). CONCLUSION: Sepsis-related ARDS has a higher overall disease severity, poorer recovery from lung injury, lower successful extubation rate, and higher mortality than non-sepsis-related ARDS. Worse clinical outcomes in sepsis-related ARDS appear to be driven by disease severity and comorbidities.
PMID: 20507948 [PubMed - as supplied by publisher]