title: Early risk factors and the role of fluid administration in developing acute respiratory distress syndrome in septic patients.
abstract: BACKGROUND
  Sepsis is a major risk factor for acute respiratory distress syndrome (ARDS). However, there remains a paucity of literature examining risk factors for ARDS in septic patients early in their course. This study examined the role of early fluid administration and identified other risk factors within the first 6 h of hospital presentation associated with developing ARDS in septic patients.
  
  
  METHODS
  This was a secondary analysis of septic adult patients presenting to the Emergency Department or being admitted for high-risk elective surgery from the multicenter observational cohort study, US Critical Injury and Illness trial Group-Lung Injury Prevention Study 1 (USCIITG-LIPS 1, NCT00889772). Multivariable logistic regression was performed to identify potential early risk factors for ARDS. Stratified analysis by shock status was performed to examine the association between early fluid administration and ARDS.
  
  
  RESULTS
  Of the 5584 patients in the original study cohort, 2534 (45.4%) met our criteria for sepsis. One hundred and fifty-six (6.2%) of these patients developed ARDS during the hospital stay. In multivariable analyses, Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR 1.10, 95% CI 1.07-1.13), age (OR 0.97, 95% CI 0.96-0.98), total fluid infused in the first 6 h (in liters) (OR 1.15, 95% CI 1.03-1.29), shock (OR 2.57, 95% CI 1.62-4.08), pneumonia as a site of infection (OR 2.31, 95% CI 1.59-3.36), pancreatitis (OR 3.86, 95% CI 1.33-11.24), and acute abdomen (OR 3.77, 95% CI 1.37-10.41) were associated with developing ARDS. In the stratified analysis, total fluid infused in the first 6 h (in liters) (OR 1.05, 95% CI 0.87-1.28) was not associated with the development of ARDS in the shock group, while there was an association in the non-shock group (OR 1.21, 95% CI 1.05-1.38).
  
  
  CONCLUSIONS
  In septic patients, the following risk factors identified within the first 6 h of hospital presentation were associated with ARDS: APACHE II score, presence of shock, pulmonary source of infection, pancreatitis, and presence of an acute abdomen. In septic patients without shock, the amount of fluid infused during the first 6 h of hospital presentation was associated with developing ARDS.
authors.affiliation: Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA. rseethala@bwh.harvard.edu.|Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA. rseethala@bwh.harvard.edu.
authors.forename: Raghu R
authors.initials: RR
authors.lastname: Seethala
authors.affiliation: Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA.|Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hou
authors.affiliation: Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA.
authors.forename: Imoigele P
authors.initials: IP
authors.lastname: Aisiku
authors.affiliation: Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA.|Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Pauline K
authors.initials: PK
authors.lastname: Park
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, UCLA, Los Angeles, CA, USA.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Chang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sevransky
keywords: Acute lung injury; Acute respiratory distress syndrome; Fluid resuscitation; Pneumonia; Sepsis