Pulmonary vs nonpulmonary sepsis and mortality in acute lung injury.
BACKGROUND
Acute lung injury (ALI) is a frequent complication of sepsis. It is unclear if a pulmonary vs nonpulmonary source of sepsis affects mortality in patients with sepsis-induced ALI.


METHODS
Two hundred eighty-eight consecutive patients with sepsis-induced ALI from 14 ICUs at four hospitals in Baltimore, MD were prospectively classified as having a pulmonary vs nonpulmonary source of sepsis. Multiple logistic regression was conducted to evaluate the independent association of a pulmonary vs nonpulmonary source of sepsis with inpatient mortality.


RESULTS
In an unadjusted analysis, in-hospital mortality was lower for pulmonary vs nonpulmonary source of sepsis (42% vs 66%, p < 0.0001). Patients with pulmonary sepsis had lower acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, shorter ICU stays prior to the development of ALI, and higher lung injury scores. In the adjusted analysis, several factors were predictive of mortality: age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.06), Charlson comorbidity index (OR, 1.15; 95% CI, 1.02 to 1.30), ICU length of stay prior to ALI diagnosis (OR, 1.19; 95% CI, 1.01 to 1.39), APACHE II score (OR, 1.07; 95% CI, 1.03 to 1.12), lung injury score (OR, 1.64; 95% CI, 1.11 to 2.43), SOFA score (OR, 1.15; 95% CI, 1.06 to 1.26), and cumulative fluid balance in the first 7 days after ALI diagnosis (OR, 1.06; 95% CI, 1.03 to 1.10). A pulmonary vs nonpulmonary source of sepsis was not independently associated with mortality (OR, 0.72; 95% CI, 0.38 to 1.35).


CONCLUSIONS
Although lower mortality was observed for ALI patients with a pulmonary vs nonpulmonary source of sepsis, this finding is likely due to a lower severity of illness in those with pulmonary sepsis. Pulmonary vs nonpulmonary source of sepsis was not independently predictive of mortality for patients with ALI.
Sevransky
Jonathan E
JE
Division of Pulmonary and Critical Care, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: jsevran1@jhmi.edu.
Martin
Greg S
GS
Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA.
Mendez-Tellez
Pedro
P
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Shanholtz
Carl
C
Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD.
Brower
Roy
R
Division of Pulmonary and Critical Care, Johns Hopkins Medical Institutions, Baltimore, MD.
Pronovost
Peter J
PJ
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD.
Needham
Dale M
DM
Division of Pulmonary and Critical Care, Johns Hopkins Medical Institutions, Baltimore, MD.
D018806:APACHE; D000328:Adult; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications* / Q000382:microbiology / Q000503:physiopathology; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D018805:Sepsis / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D012720:Severity of Illness Index