Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

Hiroki Iriyama; Toshikazu Abe; Shigeki Kushimoto; Seitaro Fujishima; Hiroshi Ogura; Atsushi Shiraishi; Daizoh Saitoh; Toshihiko Mayumi; Toshio Naito; Akira Komori; Toru Hifumi; Yasukazu Shiino; Taka-Aki Nakada; Takehiko Tarui; Yasuhiro Otomo; Kohji Okamoto; Yutaka Umemura; Joji Kotani; Yuichiro Sakamoto; Junichi Sasaki; Shin-Ichiro Shiraishi; Kiyotsugu Takuma; Ryosuke Tsuruta; Akiyoshi Hagiwara; Kazuma Yamakawa; Tomohiko Masuno; Naoshi Takeyama; Norio Yamashita; Hiroto Ikeda; Masashi Ueyama; Satoshi Fujimi; Satoshi Gando; JAAM FORECAST group

doi:10.1186/s40560-020-0426-9

Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

J Intensive Care. 2020 Jan 10:8:7. doi: 10.1186/s40560-020-0426-9. eCollection 2020.

Authors

Hiroki Iriyama¹, Toshikazu Abe^{1

2

3}, Shigeki Kushimoto⁴, Seitaro Fujishima⁵, Hiroshi Ogura⁶, Atsushi Shiraishi⁷, Daizoh Saitoh⁸, Toshihiko Mayumi⁹, Toshio Naito¹, Akira Komori¹, Toru Hifumi¹⁰, Yasukazu Shiino¹¹, Taka-Aki Nakada¹², Takehiko Tarui¹³, Yasuhiro Otomo¹⁴, Kohji Okamoto¹⁵, Yutaka Umemura⁶, Joji Kotani¹⁶, Yuichiro Sakamoto¹⁷, Junichi Sasaki¹⁸, Shin-Ichiro Shiraishi¹⁹, Kiyotsugu Takuma²⁰, Ryosuke Tsuruta²¹, Akiyoshi Hagiwara²², Kazuma Yamakawa²³, Tomohiko Masuno²⁴, Naoshi Takeyama²⁵, Norio Yamashita²⁶, Hiroto Ikeda²⁷, Masashi Ueyama²⁸, Satoshi Fujimi²³, Satoshi Gando^{29

30}; JAAM FORECAST group

Collaborators

JAAM FORECAST group:
Osamu Tasaki, Yasumitsu Mizobata, Hiraku Funakoshi, Toshiro Okuyama, Iwao Yamashita, Toshio Kanai, Yasuo Yamada, Mayuki Aibiki, Keiji Sato, Susumu Yamashita, Susumu Yamashita, Kenichi Yoshida, Shunji Kasaoka, Akihide Kon, Hiroshi Rinka, Hiroshi Kato, Hiroshi Okudera, Eichi Narimatsu, Toshifumi Fujiwara, Manabu Sugita, Yasuo Shichinohe, Hajime Nakae, Ryouji Iiduka, Mitsunobu Nakamura, Yuji Murata, Yoshitake Sato, Hiroyasu Ishikura, Yasuhiro Myojo, Yasuyuki Tsujita, Kosaku Kinoshita, Hiroyuki Yamaguchi, Toshihiro Sakurai, Satoru Miyatake, Takao Saotome, Susumu Yasuda, Toshikazu Abe, Hiroshi Ogura, Yutaka Umemura, Atsushi Shiraishi, Shigeki Kushimoto, Daizoh Saitoh, Seitaro Fujishima, Junichi Sasaki, Toshihiko Mayumi, Yasukazu Shiino, Taka-Aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Joji Kotani, Yuichiro Sakamoto, Shin-Ichiro Shiraishi, Kiyotsugu Takuma, Ryosuke Tsuruta, Akiyoshi Hagiwara, Kazuma Yamakawa, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Yasuaki Mizushima, Satoshi Gando

Affiliations

¹ 1Department of General Medicine, Juntendo University, 2-1-1 Hongo, 103 Bunkyo-ku, Tokyo, 113-0033 Japan.
² 2Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan.
³ 3Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁴ 4Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
⁵ 5Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan.
⁶ 6Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
⁷ 7Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan.
⁸ 8Division of Traumatology, Research Institute, National Defense Medical College, Tokyo, Japan.
⁹ 9Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
¹⁰ 10Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan.
¹¹ 11Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan.
¹² 12Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
¹³ 13Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Japan.
¹⁴ 14Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁵ Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan.
¹⁶ 16Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁷ 17Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan.
¹⁸ 18Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
¹⁹ Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizuwakamatsu, Japan.
²⁰ 20Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan.
²¹ 21Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Ube, Japan.
²² Department of Emergency Medicine, Niizashiki Chuo General Hospital, Niiza, Japan.
²³ Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
²⁴ 24Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
²⁵ 25Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute, Japan.
²⁶ 26Advanced Emergency Medical Service Center, Kurume University Hospital, Kurume, Japan.
²⁷ 27Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.
²⁸ 28Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Japan.
²⁹ 29Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
³⁰ 30Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.

Abstract

Background: Predisposing conditions and risk modifiers instead of causes and risk factors have recently been used as alternatives to identify patients at a risk of acute respiratory distress syndrome (ARDS). However, data regarding risk modifiers among patients with non-pulmonary sepsis is rare.

Methods: We conducted a secondary analysis of the multicenter, prospective, Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) cohort study that was conducted in 59 intensive care units (ICUs) in Japan during January 2016-March 2017. Adult patients with severe sepsis caused by non-pulmonary infection were included, and the primary outcome was having ARDS, defined as meeting the Berlin definition on the first or fourth day of screening. Multivariate logistic regression modeling was used to identify risk modifiers associated with ARDS, and odds ratios (ORs) and their 95% confidence intervals were reported. The following explanatory variables were then assessed: age, sex, admission source, body mass index, smoking status, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, steroid use, statin use, infection site, septic shock, and acute physiology and chronic health evaluation (APACHE) II score.

Results: After applying inclusion and exclusion criteria, 594 patients with non-pulmonary sepsis were enrolled, among whom 85 (14.3%) had ARDS. Septic shock was diagnosed in 80% of patients with ARDS and 66% of those without ARDS (p = 0.01). APACHE II scores were higher in patients with ARDS [26 (22-33)] than in those without ARDS [21 (16-28), p < 0.01]. In the multivariate logistic regression model, the following were independently associated with ARDS: ICU admission source [OR, 1.89 (1.06-3.40) for emergency department compared with hospital wards], smoking status [OR, 0.18 (0.06-0.59) for current smoking compared with never smoked], infection site [OR, 2.39 (1.04-5.40) for soft tissue infection compared with abdominal infection], and APACHE II score [OR, 1.08 (1.05-1.12) for higher compared with lower score].

Conclusions: Soft tissue infection, ICU admission from an emergency department, and a higher APACHE II score appear to be the risk modifiers of ARDS in patients with non-pulmonary sepsis.

Keywords: Acute respiratory distress syndrome; acute respiratory failure; sepsis.