title: Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock.
abstract: Sepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI.
  
  
  
  Secondary analysis of a multicenter, prospective, observational study was performed.
  
  
  
  Among 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American-European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes.
  
  
  
  In severe sepsis and septic shock, the proportion and effect on outcome was not uniform among infection sites. The infection site was predictive of outcome in patients with ALI but not in those without ALI.
authors.affiliation: Center for General Medicine Education, School of Medicine, Keio University, Minato, Japan.
authors.forename: Seitaro
authors.initials: S
authors.lastname: Fujishima
authors.affiliation: Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gando
authors.affiliation: Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Saitoh
authors.initials: S
authors.lastname: Daizoh
authors.affiliation: Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kushimoto
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.affiliation: Emergency & Critical Care Center, Kawasaki Municipal Hospital, Kawasaki, Japan.
authors.forename: Kiyotsugu
authors.initials: K
authors.lastname: Takuma
authors.affiliation: Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kotani
authors.affiliation: Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Kurume, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Yamashita
authors.affiliation: Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tsuruta
authors.affiliation: Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Toyoake, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Takeyama
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Shiraishi
authors.affiliation: Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital.
authors.forename: Tsunetoshi
authors.initials: T
authors.lastname: Araki
authors.affiliation: Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Ikeda
authors.affiliation: Advanced Critical Care Center Aichi Medical University Hospital, Nagakute, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Miki
authors.affiliation: Department of Critical Care Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Trauma & Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.affiliation: Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Aikawa
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D015984:Causality; D019468:Disease Management; D005260:Female; D005490:Focal Infection / Q000150:complications / Q000175:diagnosis; D017052:Hospital Mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008171:Lung Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D012772:Shock, Septic / Q000150:complications / Q000453:epidemiology / Q000628:therapy
keywords: acute lung injury; acute respiratory distress syndrome; disseminated intravascular coagulation; multiple organ dysfunction syndrome; severe sepsis