Mortality in sepsis versus non-sepsis induced acute lung injury.
BACKGROUND
Sepsis-induced acute lung injury (ALI) has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding.


METHODS
520 patients enrolled in the Improving Care of ALI Patients Study (ICAP) were prospectively characterized as having sepsis or non sepsis-induced ALI. Biologically plausible risk factors for in-hospital death were considered in multiple logistic regression models to evaluate the independent association of sepsis vs. non-sepsis ALI risk factors with mortality.


RESULTS
Patients with sepsis-induced ALI had greater illness severity and organ dysfunction (APACHE II and SOFA scores) at ALI diagnosis and higher crude in-hospital mortality rates compared with non-sepsis ALI patients. Patients with sepsis-induced ALI received similar tidal volumes, but higher levels of positive end expiratory pressure, and had a more positive net fluid balance in the first week after ALI diagnosis. In multivariable analysis, the following variables (odds ratio, 95% confidence interval) were significantly associated with hospital mortality: age (1.04, 1.02 to 1.05), admission to a medical intensive care unit (ICU) (2.76, 1.42 to 5.36), ICU length of stay prior to ALI diagnosis (1.15, 1.03 to 1.29), APACHE II (1.05, 1.02 to 1.08), SOFA at ALI diagnosis (1.17, 1.09 to 1.25), Lung Injury Score (2.33, 1.74 to 3.12) and net fluid balance in liters in the first week after ALI diagnosis (1.06, 1.03 to 1.09). Sepsis did not have a significant, independent association with mortality (1.02, 0.59 to 1.76).


CONCLUSIONS
Greater severity of illness contributes to the higher case fatality rate observed in sepsis-induced ALI. Sepsis was not independently associated with mortality in our study.
Sevransky
Jonathan E
JE
Division of Pulmonary and Critical Care, Johns Hopkins University, 5501 Hopkins Bayview Circle Baltimore, MD 21224 USA. jsevran1@jhmi.edu
Martin
Gregory S
GS
Shanholtz
Carl
C
Mendez-Tellez
Pedro A
PA
Pronovost
Peter
P
Brower
Roy
R
Needham
Dale M
DM
D055371:Acute Lung Injury / Q000209:etiology / Q000276:immunology / Q000401:mortality* / Q000503:physiopathology; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000276:immunology; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology