Center for General Medicine Education, School of Medicine, Keio University, Minato, Japan.
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Respirology. 2016 Jul;21(5):898-904. doi: 10.1111/resp.12769. Epub 2016 Mar 30.
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.
Secondary analysis of a multicenter, prospective, observational study was performed.
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.
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.
脓毒症是急性肺损伤（ALI）的主要病因，但脓毒症相关 ALI 的特征和结局仍知之甚少。本研究旨在阐明预测脓毒症相关 ALI 患者预后的因素。
对一项多中心、前瞻性、观察性研究进行了二次分析。
在 624 例严重脓毒症和脓毒性休克患者中，251 例（40.2%）符合美国-欧洲共识会议ALI 定义。所有原因的 28 天和住院死亡率分别为 30.7%和 38.6%。超过 40%的 ALI 患者存在神经、心血管和血液系统功能障碍或弥散性血管内凝血，所有这些都与更高的死亡率相关。我们报告了 ALI 患者感染部位与死亡率之间存在显著相关性，但在无 ALI 患者中则不存在。在 ALI 患者中，肺部感染的 ALI 比例明显更高；此外，ALI 的并发症与肺部和其他来源的脓毒症的死亡率更高相关，但与腹部脓毒症无关。在其他脓毒症部位中，与 ALI 相关的尿路感染、中枢神经系统感染、导管相关感染和未确定感染部位的感染预后更差。包括液体复苏和早期抗生素治疗在内的单个严重脓毒症治疗包均与死亡率无关。遵守一组脓毒症管理包与更好的结果相关。
在严重脓毒症和脓毒性休克中，感染部位的比例和对结局的影响并不统一。感染部位可预测 ALI 患者的结局，但不能预测无 ALI 患者的结局。
