Shah Chirag V, Localio A R, Lanken Paul N, Kahn Jeremy M, Bellamy Scarlett, Gallop Robert, Finkel Barbara, Gracias Vicente H, Fuchs Barry D, Christie Jason D
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Crit Care Med. 2008 Aug;36(8):2309-15. doi: 10.1097/CCM.0b013e318180dc74.
The additional impact of development of acute lung injury on mortality in severely-injured trauma patients beyond baseline severity of illness has been questioned. We assessed the contribution of acute lung injury to in-hospital mortality in critically ill trauma patients.
Prospective cohort study. The contribution of acute lung injury to in-hospital mortality was evaluated in two ways. First, multivariable logistic regression models were used to test the independent association of acute lung injury with in-hospital mortality while adjusting for baseline confounding variables. Second, causal pathway models were used to estimate the amount of the overall association of baseline severity of illness with in-hospital mortality that is attributable to the interval development of acute lung injury.
Academic level 1 trauma center.
Two hundred eighty-three critically ill trauma patients without isolated head injury and with an Injury Severity Score > or = 16 were evaluated for development of acute lung injury in the first 5 days after trauma.
Of the 283 patients, 38 (13.4%) died. The unadjusted mortality rate was nearly three-fold greater in the acute lung injury group (23.9% vs. 8.4%; odds ratio = 3.36; 95% confidence interval 1.67-6.77; p = 0.001). Acute lung injury remained an independent risk factor for death after adjustment for age, baseline Acute Physiologic and Chronic Health Evaluation III score, Injury Severity Score, and blunt mechanism of injury (odds ratio = 2.87; 95% confidence interval 1.29-6.37; p = 0.010). Forty percent of the total association of the baseline Acute Physiologic and Chronic Health Evaluation III score with mortality occurred via an indirect association through acute lung injury, and the remaining 60% via a direct effect.
Development of acute lung injury in critically ill trauma patients without isolated head injury contributes independently to in-hospital mortality beyond baseline severity of illness measures. In addition, a significant portion of the association between baseline illness severity and risk of death in these patients might be explained by the interval development of acute lung injury.
急性肺损伤的发生对重伤创伤患者死亡率的额外影响，超出了疾病的基线严重程度，这一点受到了质疑。我们评估了急性肺损伤对重症创伤患者院内死亡率的影响。
前瞻性队列研究。通过两种方式评估急性肺损伤对院内死亡率的影响。首先，使用多变量逻辑回归模型，在调整基线混杂变量的同时，测试急性肺损伤与院内死亡率之间的独立关联。其次，使用因果路径模型来估计疾病基线严重程度与院内死亡率之间的总体关联中，归因于急性肺损伤间期发展的部分。
一级学术创伤中心。
283例重症创伤患者，无孤立性头部损伤且损伤严重度评分≥16，在创伤后的前5天内评估急性肺损伤的发生情况。
283例患者中，38例（13.4%）死亡。急性肺损伤组未调整的死亡率几乎高出三倍（23.9%对8.4%；比值比=3.36；95%置信区间1.67 - 6.77；p = 0.001）。在调整年龄、基线急性生理与慢性健康状况评估III评分、损伤严重度评分和钝性损伤机制后，急性肺损伤仍然是死亡的独立危险因素（比值比=2.87；95%置信区间1.29 - 6.37；p = 0.010）。基线急性生理与慢性健康状况评估III评分与死亡率之间的总体关联中，40%通过急性肺损伤的间接关联发生，其余60%通过直接效应发生。
无孤立性头部损伤的重症创伤患者发生急性肺损伤，独立导致了超出疾病基线严重程度指标的院内死亡率。此外，这些患者基线疾病严重程度与死亡风险之间的显著关联部分，可能由急性肺损伤的间期发展来解释。
