Nonpulmonary risk factors of acute respiratory distress syndrome in patients with septic bacteraemia

• Published in: The Korean journal of internal medicine 2019, 34(1), , pp.116-124
• Main Authors: Nam, Hyunseung, Jang, Seung Hun, Hwang, Yong Il, Kim, Joo-Hee, Park, Ji Young, Park, Sunghoon
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; bacteremia; Bacteremia - complications; Bacteremia - mortality; Blood Coagulation Disorders - complications; Central Nervous System Diseases - complications; Female; Hospital Mortality; Humans; Incidence; Intensive Care Units; Kaplan-Meier Estimate; Male; Middle Aged; Multiple Organ Failure - complications; Multiple Organ Failure - mortality; organ failure; Original; Republic of Korea - epidemiology; respiratory distress syndrome, adult; Respiratory Distress Syndrome, Adult - epidemiology; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Retrospective Studies; Risk Factors; sepsis; Tertiary Care Centers; 내과학
• ISSN: 1226-3303; 2005-6648
• DOI: 10.3904/kjim.2017.204

The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied. We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016. The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality. Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.