Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome.
Cigarette Smoke Exposure and the Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000001089
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发表时间：
2015-09
影响因子：
8.8
通讯作者：
Ware LB
中科院分区：
文献类型：
--
作者：
Calfee CS;Matthay MA;Kangelaris KN;Siew ED;Janz DR;Bernard GR;May AK;Jacob P;Havel C;Benowitz NL;Ware LB
吸烟暴露与急性呼吸窘迫综合征（ARDS）患者中最常见的ARDS危险因素（脓毒症、肺炎和误吸）之间的关系尚未得到充分研究。本研究的目的是在一个不同的队列中检测生物标志物证实的吸烟与ARDS之间的关联。我们在一个三级护理中心的一个前瞻性危重患者队列中，对426例有ARDS危险因素（不包括创伤和输血）的患者进行了吸烟史和尿NNAL（香烟烟雾暴露的生物标志物）测量，并测试了吸烟与ARDS之间的关系。没有。香烟烟雾暴露和ARDS之间的关联基于ARDS危险因素而不同（相互作用p<0.02）。在以非肺脓毒症为主要ARDS危险因素的患者中（n=212），39%的ARDS患者目前有吸烟史，而无ARDS的患者为22%（比值比2.28（95%CI 1.24-4.18）; p=0.007）。同样，通过尿NNAL测量的香烟烟雾暴露与该组中的ARDS显著相关。非肺性脓毒症中ARDS风险增加仅限于NNAL水平与主动吸烟一致的患者，并且对其他ARDS预测因子的调整具有鲁棒性。在有其他危险因素（如肺炎、误吸）的患者中，通过病史或NNAL测量的香烟烟雾暴露与ARDS无关。在非肺脓毒症患者中，通过病史和生物标志物测量的吸烟与ARDS风险增加相关。这一发现对烟草产品监管和了解ARDS的发病机制具有重要意义。
The association between cigarette smoke exposure and the acute respiratory distress syndrome (ARDS) in patients with the most common ARDS risk factors of sepsis, pneumonia, and aspiration has not been well-studied. The goal of this study was to test the association between biomarker-confirmed cigarette smoking and ARDS in a diverse cohort. We obtained smoking histories and measured urine NNAL (a biomarker of cigarette smoke exposure) in 426 patients with ARDS risk factors (excluding trauma and transfusion) in a prospective cohort of critically ill patients at a single tertiary care center and tested the association between smoking and ARDS. None. The association between cigarette smoke exposure and ARDS differed based on ARDS risk factor (p<0.02 for interaction). In patients with non-pulmonary sepsis as the primary ARDS risk factor (n=212), 39% of those with ARDS were current smokers by history, compared with 22% of those without ARDS (odds ratio 2.28 (95% CI 1.24–4.18); p=0.007). Likewise, cigarette smoke exposure as measured by urine NNAL was significantly associated with ARDS in this group. The increased risk of ARDS in non-pulmonary sepsis was restricted to patients with NNAL levels consistent with active smoking and was robust to adjustment for other ARDS predictors. Cigarette smoke exposure as measured by history or NNAL was not associated with ARDS in patients with other risk factors (e.g. pneumonia, aspiration). Cigarette smoking measured both by history and by biomarker is associated with an increased risk of ARDS in patients with non-pulmonary sepsis. This finding has important implications for tobacco product regulation and for understanding the pathogenesis of ARDS.