Seethala Raghu R, Hou Peter C, Aisiku Imoigele P, Frendl Gyorgy, Park Pauline K, Mikkelsen Mark E, Chang Steven Y, Gajic Ognjen, Sevransky Jonathan
Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Neville House, Boston, MA, 02115, USA.
Surgical ICU Translational Research (STAR) Center, Brigham and Women's Hospital, Boston, MA, USA.
Ann Intensive Care. 2017 Dec;7(1):11. doi: 10.1186/s13613-017-0233-1. Epub 2017 Jan 23.
Sepsis is a major risk factor for acute respiratory distress syndrome (ARDS). However, there remains a paucity of literature examining risk factors for ARDS in septic patients early in their course. This study examined the role of early fluid administration and identified other risk factors within the first 6 h of hospital presentation associated with developing ARDS in septic patients.
This was a secondary analysis of septic adult patients presenting to the Emergency Department or being admitted for high-risk elective surgery from the multicenter observational cohort study, US Critical Injury and Illness trial Group-Lung Injury Prevention Study 1 (USCIITG-LIPS 1, NCT00889772). Multivariable logistic regression was performed to identify potential early risk factors for ARDS. Stratified analysis by shock status was performed to examine the association between early fluid administration and ARDS.
Of the 5584 patients in the original study cohort, 2534 (45.4%) met our criteria for sepsis. One hundred and fifty-six (6.2%) of these patients developed ARDS during the hospital stay. In multivariable analyses, Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR 1.10, 95% CI 1.07-1.13), age (OR 0.97, 95% CI 0.96-0.98), total fluid infused in the first 6 h (in liters) (OR 1.15, 95% CI 1.03-1.29), shock (OR 2.57, 95% CI 1.62-4.08), pneumonia as a site of infection (OR 2.31, 95% CI 1.59-3.36), pancreatitis (OR 3.86, 95% CI 1.33-11.24), and acute abdomen (OR 3.77, 95% CI 1.37-10.41) were associated with developing ARDS. In the stratified analysis, total fluid infused in the first 6 h (in liters) (OR 1.05, 95% CI 0.87-1.28) was not associated with the development of ARDS in the shock group, while there was an association in the non-shock group (OR 1.21, 95% CI 1.05-1.38).
In septic patients, the following risk factors identified within the first 6 h of hospital presentation were associated with ARDS: APACHE II score, presence of shock, pulmonary source of infection, pancreatitis, and presence of an acute abdomen. In septic patients without shock, the amount of fluid infused during the first 6 h of hospital presentation was associated with developing ARDS.
脓毒症是急性呼吸窘迫综合征（ARDS）的主要危险因素。然而，关于脓毒症患者病程早期ARDS危险因素的文献仍然匮乏。本研究探讨了早期液体输注的作用，并确定了脓毒症患者入院后最初6小时内与发生ARDS相关的其他危险因素。
这是一项对多中心观察性队列研究——美国重症损伤与疾病试验组-肺损伤预防研究1（USCIITG-LIPS 1，NCT00889772）中就诊于急诊科或因高危择期手术入院的成年脓毒症患者进行的二次分析。采用多变量逻辑回归来确定ARDS的潜在早期危险因素。通过休克状态进行分层分析，以研究早期液体输注与ARDS之间的关联。
在原研究队列的5584例患者中，2534例（45.4%）符合我们的脓毒症标准。其中156例（6.2%）患者在住院期间发生了ARDS。在多变量分析中，急性生理与慢性健康状况评分（APACHE）II（比值比[OR]1.10，95%置信区间[CI]1.07 - 1.13）、年龄（OR 0.97，95% CI 0.96 - 0.98）、最初6小时内输注的总液体量（以升计）（OR 1.15，95% CI 1.03 - 1.29）、休克（OR 2.57，95% CI 1.62 - 4.08）、肺炎作为感染部位（OR 2.31，95% CI 1.59 - 3.36）、胰腺炎（OR 3.86，95% CI 1.33 - 11.24）和急腹症（OR 3.77，95% CI 1.37 - 10.41）与发生ARDS相关。在分层分析中，最初6小时内输注的总液体量（以升计）（OR 1.05，95% CI 0.87 - 1.28）在休克组与ARDS的发生无关，而在非休克组存在关联（OR 1.21，95% CI 1.05 - 1.38）。
在脓毒症患者中，入院后最初6小时内确定的以下危险因素与ARDS相关：APACHE II评分、休克的存在、肺部感染源、胰腺炎和急腹症的存在。在无休克的脓毒症患者中，入院后最初6小时内输注的液体量与发生ARDS相关。
