The influence of infection sites on development and mortality of ARDS

• Published in: Intensive care medicine 2010-06, Vol.36 (6), p.963-970
• Main Authors: Sheu, Chau-Chyun, Gong, Michelle N., Zhai, Rihong, Bajwa, Ednan K., Chen, Feng, Taylor Thompson, B., Christiani, David C.
• Format: Article
• Language: English
• Subjects: Acute respiratory distress syndrome; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Bacterial pneumonia; Biological and medical sciences; Critical care; Critical Care Medicine; Critical Illness; Edema; Emergency Medicine; Epidemiology; Female; Health aspects; Hospitals; Human viral diseases; Humans; Infections; Infections - classification; Infections - mortality; Infectious diseases; Intensive; Intensive care; Intensive care medicine; Male; Massachusetts - epidemiology; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Mortality; Observation; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Pneumonia; Prospective Studies; Public health; Respiratory distress syndrome; Respiratory Distress Syndrome - mortality; Respiratory Distress Syndrome - physiopathology; Risk Assessment; Risk Factors; Sepsis; Trauma; Urogenital system; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1851-3

Objective Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients. Design Prospective observational study. Setting Adult intensive care units (ICUs) of an academic medical center. Patients Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During follow-up, 549 patients developed ARDS and 212 of them died within 60 days. Main results The distribution of infection sites in ARDS patients was: lung (77.2%), abdomen (19.3%), skin/soft tissues (6.0%), urinary tract (4.7%), unknown (2.6%), and multiple sites (17.7%). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection. Conclusions In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.