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01-06-2020 | Septicemia | Original

Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis

Authors: Catherine L. Auriemma, Hanjing Zhuo, Kevin Delucchi, Thomas Deiss, Tom Liu, Alejandra Jauregui, Serena Ke, Kathryn Vessel, Matthew Lippi, Eric Seeley, Kirsten N. Kangelaris, Antonio Gomez, Carolyn Hendrickson, Kathleen D. Liu, Michael A. Matthay, Lorraine B. Ware, Carolyn S. Calfee

Published in: Intensive Care Medicine | Issue 6/2020

Abstract

Purpose

Previous studies assessing impact of acute respiratory distress syndrome (ARDS) on mortality have shown conflicting results. We sought to assess the independent association of ARDS with in-hospital mortality among intensive care unit (ICU) patients with sepsis.

Methods

We studied two prospective sepsis cohorts drawn from the Early Assessment of Renal and Lung Injury (EARLI; n = 474) and Validating Acute Lung Injury markers for Diagnosis (VALID; n = 337) cohorts. ARDS was defined by Berlin criteria. We used logistic regression to compare in-hospital mortality in patients with and without ARDS, controlling for baseline severity of illness. We also estimated attributable mortality, adjusted for illness severity by stratification.

Results

ARDS occurred in 195 EARLI patients (41%) and 99 VALID patients (29%). ARDS was independently associated with risk of hospital death in multivariate analysis, even after controlling for severity of illness, as measured by APACHE II (odds ratio [OR] 1.65 (95% confidence interval [CI] 1.02, 2.67), p = 0.04 in EARLI; OR 2.12 (CI 1.16, 3.92), p = 0.02 in VALID). Patients with severe ARDS (P/F < 100) primarily drove this relationship. The attributable mortality of ARDS was 27% (CI 14%, 37%) in EARLI and 37% (CI 10%, 51%) in VALID. ARDS was independently associated with ICU mortality, hospital length of stay (LOS), ICU LOS, and ventilator-free days.

Conclusions

Development of ARDS among ICU patients with sepsis confers increased risk of ICU and in-hospital mortality in addition to other important outcomes. Clinical trials targeting patients with severe ARDS will be best poised to detect measurable differences in these outcomes.

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Title: Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis
Authors: Catherine L. Auriemma
Hanjing Zhuo
Kevin Delucchi
Thomas Deiss
Tom Liu
Alejandra Jauregui
Serena Ke
Kathryn Vessel
Matthew Lippi
Eric Seeley
Kirsten N. Kangelaris
Antonio Gomez
Carolyn Hendrickson
Kathleen D. Liu
Michael A. Matthay
Lorraine B. Ware
Carolyn S. Calfee
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Septicemia
Septicemia
Acute Respiratory Distress-Syndrome
Published in: Intensive Care Medicine / Issue 6/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06010-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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