title: Acute respiratory distress syndrome after bacteremic sepsis does not increase mortality.
abstract: To determine whether acute respiratory distress syndrome (ARDS) complicating bacteremic sepsis independently affects mortality in critically ill patients, we conducted a 3-year retrospective cohort study in a surgical intensive care unit. We included all consecutive patients with blood culture-positive sepsis and measured organ dysfunctions and mortality. Among 4,530 admissions, 196 cases of bacteremic sepsis were recorded. ARDS occurred in 31 (16%) of these patients. The case fatality rate was 58% in patients with ARDS compared with 31% in patients without ARDS. Using Cox proportional hazards regression with time-dependent variables, the unadjusted hazard ratio for death was 1.8 (95% confidence interval [CI], 1.0-3.2). After adjusting for comorbid factors that were present before the onset of sepsis, the hazard ratio was 2.2 (95% CI, 1.2-3.9). After further adjustment was made for nonpulmonary organ dysfunctions and microbiologic factors that were independently associated with mortality, the adjusted hazard ratio for ARDS was 0.6 (95% CI, 0.3-1.2). Among critically ill surgical patients, ARDS complicating bacteremic sepsis remains common, but it is not independently associated with short-term mortality, after adjusting for severity of illness and nonpulmonary organ dysfunctions evolving after the onset of sepsis.
authors.affiliation: Department of Medicine, Infection Control Program, University of Geneva Hospitals, 1211 Geneva 14, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Bara
authors.initials: B
authors.lastname: Ricou
authors.forename: Stephane
authors.initials: S
authors.lastname: Hugonnet
authors.forename: Karin
authors.initials: K
authors.lastname: Ferriere
authors.forename: Peter
authors.initials: P
authors.lastname: Suter
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D016470:Bacteremia / Q000097:blood / Q000150:complications* / Q000401:mortality*; D002423:Cause of Death; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012128:Respiratory Distress Syndrome / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D013557:Switzerland / Q000453:epidemiology