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Pulmonary versus Non-Pulmonary Sepsis and Mortality in Acute Lung Injury

¹Division of Pulmonary and Critical Care, Johns Hopkins Medical Institutions, Baltimore, MD ²Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA ³Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD ⁴Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD

Abstract

BackgroundAcute lung injury (ALI) is a frequent complication of sepsis. It is unclear if a pulmonary vs. non-pulmonary source of sepsis affects mortality in patients with sepsis-induced ALI.

Methods288 consecutive patients with sepsis-induced ALI from 14 ICUs at 4 hospitals in Baltimore, MD were prospectively classified as having a pulmonary versus non-pulmonary source of sepsis. Multiple logistic regression was conducted to evaluate the independent association of a pulmonary vs. non-pulmonary source of sepsis with in-patient mortality.

ResultsIn an unadjusted analysis, in-hospital mortality was lower for pulmonary vs. non-pulmonary source of sepsis (42% vs. 66%, p< 0.0001). Patients with pulmonary sepsis had lower APACHE II and SOFA scores, shorter ICU stays prior to developing ALI and higher lung injury scores. In the adjusted analysis, several factors were predictive of mortality (odds ratio, 95% confidence interval): age (1.03, 1.01-1.06), Charlson Comorbidity Index (1.15,1.02-1.30), ICU length of stay prior to ALI diagnosis (1.19, 1.01-1.39) APACHE II score (1.07, 1.03-1.12), lung injury score (1.64, 1.11-2.43), SOFA score (1.15, 1.06-1.26), and cumulative fluid balance in the first 7 days after ALI diagnosis (1.06, 1.03-1.10). A pulmonary vs. non-pulmonary source of sepsis was not independently associated with mortality (0.72, 0.38-1.35).

ConclusionsAlthough lower mortality was observed for ALI patients with a pulmonary vs. non-pulmonary source of sepsis, this finding is likely due to a lower severity of illness in those with pulmonary sepsis. Pulmonary versus non-pulmonary source of sepsis was not independently predictive of mortality for patients with ALI.

Key Words: Sepsis • Respiratory Distress Syndrome • Adult • Critical Illness • Mortality