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KMID : 0338420190340010116
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Korean Journal of Internal Medicine
2019 Volume.34 No. 1 p.116 ~ p.124
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Nonpulmonary risk factors of acute respiratory distress syndrome in patients with septic bacteraemia
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Nam Hyun-Seung
Jang Seung-Hun
Hwang Yong-Il
Kim Joo-Hee
Park Ji-Young
Park Sung-Hoon
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Abstract
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Background/Aims: The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied.
Methods: We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016.
Results: The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality.
Conclusions: Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.
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KEYWORD
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Respiratory distress syndrome, adult, Bacteremia, Organ failure, Sepsis
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