Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis
Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis
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DOI：
10.1007/s00134-020-06010-9
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发表时间：
2020-03-23
影响因子：
38.9
通讯作者：
Calfee, Carolyn S.
中科院分区：
文献类型：
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作者：
Auriemma, Catherine L.;Zhuo, Hanjing;Calfee, Carolyn S.
目的以往评估急性呼吸窘迫综合征（ARDS）对死亡率影响的研究显示了相互矛盾的结果。我们试图评估重症监护病房（ICU）脓毒症患者ARDS与住院死亡率的独立关联。方法：我们研究了两个前瞻性脓毒症队列，分别来自肾和肺损伤早期评估（EARLI, n = 474）和验证急性肺损伤诊断标志物（VALID, n = 337）队列。ARDS由柏林标准定义。在控制基线疾病严重程度的情况下，我们使用逻辑回归来比较有和没有ARDS患者的住院死亡率。我们还通过分层调整疾病严重程度，估计了归因死亡率。结果EARLI患者发生ARDS 195例（41%），VALID患者发生ARDS 99例（29%）。在多变量分析中，ARDS与医院死亡风险独立相关，即使在控制病情严重程度后，如APACHE II测量(优势比[OR] 1.65(95%可信区间[CI] 1.02, 2.67)，在EARLI中p = 0.04；OR 2.12 (CI 1.16, 3.92)，有效组p = 0.02)。严重急性呼吸窘迫综合征患者（P/F < 100）主要推动了这一关系。EARLI组ARDS的归因死亡率为27% (CI 14%, 37%)， VALID组为37% （CI 10%, 51%）。ARDS与ICU死亡率、住院时间（LOS）、ICU LOS和无呼吸机天数独立相关。结论ICU脓毒症患者发生ARDS，除了其他重要结局外，还增加了ICU和院内死亡的风险。针对严重急性呼吸窘迫综合征患者的临床试验将最好地检测这些结果的可测量差异。
Purpose Previous studies assessing impact of acute respiratory distress syndrome (ARDS) on mortality have shown conflicting results. We sought to assess the independent association of ARDS with in-hospital mortality among intensive care unit (ICU) patients with sepsis. Methods We studied two prospective sepsis cohorts drawn from the Early Assessment of Renal and Lung Injury (EARLI; n = 474) and Validating Acute Lung Injury markers for Diagnosis (VALID; n = 337) cohorts. ARDS was defined by Berlin criteria. We used logistic regression to compare in-hospital mortality in patients with and without ARDS, controlling for baseline severity of illness. We also estimated attributable mortality, adjusted for illness severity by stratification. Results ARDS occurred in 195 EARLI patients (41%) and 99 VALID patients (29%). ARDS was independently associated with risk of hospital death in multivariate analysis, even after controlling for severity of illness, as measured by APACHE II (odds ratio [OR] 1.65 (95% confidence interval [CI] 1.02, 2.67), p = 0.04 in EARLI; OR 2.12 (CI 1.16, 3.92), p = 0.02 in VALID). Patients with severe ARDS (P/F < 100) primarily drove this relationship. The attributable mortality of ARDS was 27% (CI 14%, 37%) in EARLI and 37% (CI 10%, 51%) in VALID. ARDS was independently associated with ICU mortality, hospital length of stay (LOS), ICU LOS, and ventilator-free days. Conclusions Development of ARDS among ICU patients with sepsis confers increased risk of ICU and in-hospital mortality in addition to other important outcomes. Clinical trials targeting patients with severe ARDS will be best poised to detect measurable differences in these outcomes.