烧伤合并吸入性损伤的成年患者中，烟草使用对急性呼吸窘迫综合征发生的促成风险。
The Contributing Risk of Tobacco Use for ARDS Development in Burn-Injured Adults With Inhalation Injury.
作者信息
Afshar Majid, Netzer Giora, Mosier Michael J, Cooper Richard S, Adams William, Burnham Ellen L, Kovacs Elizabeth J, Durazo-Arvizu Ramon, Kliethermes Stephanie
机构信息
Burn and Shock Trauma Research Institute
Department of Public Health Sciences, Stritch School of Medicine, Loyola University Health Sciences Campus, Maywood, Illinois.
出版信息
Respir Care. 2017 Nov;62(11):1456-1465. doi: 10.4187/respcare.05560. Epub 2017 Sep 12.
BACKGROUND
This study aims to determine the relationship between tobacco use, inhalation injury, and ARDS in burn-injured adults.
METHODS
This study was an observational cohort of 2,485 primary burn admissions to a referral burn center between January 1, 2008 and March 15, 2015. Subjects were evaluated by methods used to account for mediation and traditional approaches (multivariable logistic regression and propensity score analysis). Mediation analysis examined both the (1) indirect effect of tobacco use via inhalation injury as the mediator on ARDS development and (2) the direct effect of tobacco use alone on ARDS development.
RESULTS
ARDS development occurred in 6.8% ( = 170) of the cohort. Inhalation injury occurred in 5.0% ( = 125) of the cohort, and ARDS developed in 48.8% ( = 83) of the subjects with inhalation injury. Tobacco use was 2-fold more common in subjects with ARDS. In the mediated model, the direct effect of tobacco use on ARDS, including interaction between tobacco use and inhalation injury, was not significant (odds ratio [OR] 1.63, 95% CI 0.91-2.92, = .10). However, the indirect effect of tobacco use via inhalation injury as the mediator was significant (OR 1.61, 95% CI 1.25-2.07, < .001), and the proportion of the total effect of tobacco use operating through the mediator was 55.6%. In the non-mediation models (multivariable logistic regression and propensity score analysis), which controlled for inhalation injury and other covariables, the OR for the association between tobacco use and ARDS was 1.84 (95% CI 1.22-2.81, < .001) and 1.69 (95% CI 1.04-2.75, = .03), respectively.
CONCLUSIONS
In mediation analysis, inhalation injury was the overwhelming predictor for ARDS development, whereas tobacco use has its strongest effect indirectly through inhalation injury. Patients with at least moderate inhalation injury are at greatest risk for ARDS development despite baseline risk factors like tobacco use.
背景
本研究旨在确定成年烧伤患者中烟草使用、吸入性损伤与急性呼吸窘迫综合征（ARDS）之间的关系。
方法
本研究是一项观察性队列研究，纳入了2008年1月1日至2015年3月15日期间转诊至一家烧伤中心的2485例原发性烧伤患者。采用用于中介分析的方法和传统方法（多变量逻辑回归和倾向得分分析）对受试者进行评估。中介分析考察了：（1）以吸入性损伤为中介，烟草使用对ARDS发生的间接影响；（2）烟草使用单独对ARDS发生的直接影响。
结果
该队列中6.8%（n = 170）发生了ARDS。5.0%（n = 125）的队列发生了吸入性损伤，在发生吸入性损伤的受试者中，48.8%（n = 83）发生了ARDS。ARDS患者中烟草使用的情况是其他患者的2倍。在中介模型中，烟草使用对ARDS的直接影响，包括烟草使用与吸入性损伤之间的相互作用，并不显著（优势比[OR]为1.63，95%置信区间为0.91 - 2.92，P = 0.10）。然而，以吸入性损伤为中介，烟草使用的间接影响显著（OR为1.61，95%置信区间为1.25 - 2.07，P < 0.001），且通过中介起作用的烟草使用总效应的比例为55.6%。在控制了吸入性损伤和其他协变量的非中介模型（多变量逻辑回归和倾向得分分析）中，烟草使用与ARDS关联的OR分别为1.84（95%置信区间为1.22 - 2.81，P < 0.001）和1.69（95%置信区间为1.04 - 2.75，P = 0.03）。
结论
在中介分析中，吸入性损伤是ARDS发生的主要预测因素，而烟草使用通过吸入性损伤产生最强的间接影响。尽管存在烟草使用等基线风险因素，但至少有中度吸入性损伤的患者发生ARDS的风险最高。
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