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Respirology. 2016 Jul;21(5):898-904. doi: 10.1111/resp.12769. Epub 2016 Mar 30.

Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock.

Author information

1
Center for General Medicine Education, School of Medicine, Keio University, Minato, Japan.
2
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
3
Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.
4
Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
5
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
6
Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
7
Emergency & Critical Care Center, Kawasaki Municipal Hospital, Kawasaki, Japan.
8
Department of Emergency, Critical Care and Disaster Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
9
Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Kurume, Japan.
10
Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan.
11
Department of Emergency and Acute Intensive Care Medicine, Fujita Health University, Toyoake, Japan.
12
Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
13
Department of Emergency & Critical Care Medicine, Trauma Center St. Mary's Hospital.
14
Department of Acute Medicine, Kawasaki Medical School, Kurashiki, Japan.
15
Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Tokyo, Japan.
16
Advanced Critical Care Center Aichi Medical University Hospital, Nagakute, Japan.
17
Department of Critical Care Medicine, Iwate Medical University, Morioka, Japan.
18
Department of Trauma & Critical Care Medicine, School of Medicine, Kyorin University, Tokyo, Japan.
19
Department of Emergency & Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan.

Abstract

BACKGROUND AND OBJECTIVE:

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.

METHODS:

Secondary analysis of a multicenter, prospective, observational study was performed.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

acute lung injury; acute respiratory distress syndrome; disseminated intravascular coagulation; multiple organ dysfunction syndrome; severe sepsis

PMID:
27028604
DOI:
10.1111/resp.12769
[Indexed for MEDLINE]

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