Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis

Abstract

Previous studies assessing impact of acute respiratory distress syndrome (ARDS) on mortality have shown conflicting results. We sought to assess the independent association of ARDS with in-hospital mortality among intensive care unit (ICU) patients with sepsis. Methods: We studied two prospective sepsis cohorts drawn from the Early Assessment of Renal and Lung Injury (EARLI; n = 474) and Validating Acute Lung Injury markers for Diagnosis (VALID; n = 337) cohorts. ARDS was defined by Berlin criteria. We used logistic regression to compare in-hospital mortality in patients with and without ARDS, controlling for baseline severity of illness. We also estimated attributable mortality, adjusted for illness severity by stratification. Results: ARDS occurred in 195 EARLI patients (41%) and 99 VALID patients (29%). ARDS was independently associated with risk of hospital death in multivariate analysis, even after controlling for severity of illness, as measured by APACHE II (odds ratio [OR] 1.65 (95% confidence interval [CI] 1.02, 2.67), p = 0.04 in EARLI; OR 2.12 (CI 1.16, 3.92), p = 0.02 in VALID). Patients with severe ARDS (P/F < 100) primarily drove this relationship. The attributable mortality of ARDS was 27% (CI 14%, 37%) in EARLI and 37% (CI 10%, 51%) in VALID. ARDS was independently associated with ICU mortality, hospital length of stay (LOS), ICU LOS, and ventilator-free days. Conclusions: Development of ARDS among ICU patients with sepsis confers increased risk of ICU and in-hospital mortality in addition to other important outcomes. Clinical trials targeting patients with severe ARDS will be best poised to detect measurable differences in these outcomes.

Clinical Characteristics and Risk Factors of Fatal Patients with COVID-19: a Retrospective Cohort Study in Wuhan, China

“…Here, we con rmed that those with increased SOFA, qSOFA, APACHE II or SIRS score had higher death risk of COVID-19. Additionally, the AUC values predicting death risk of COVID-19 using SOFA, qSOFA, APACHE II or SIRS score attained 0.697, 0.610, 0.826 and 0.749, respectively, consistent with previous reports revealing that these scores are useful predictors of ICU mortality [18][19][20]. Strikingly, it was reported that SOFA and qSOFA scores had greater capacities predicting death in ICU cohort, compared to APACHE II or SIRS score [20,21].…”

Extracellular histones in lung dysfunction: a new biomarker and therapeutic target?

“…H2A, H2B, H3 and H4 known as core histones and H1 and H5 as designated as linker histones remain inert in the nucleus, but once released into extracellular space, they act as damage-associated molecular patters (DAMPs) and may exert profound cytotoxic effects 2,3 . Acute respiratory distress syndrome (ARDS) and severe sepsis still remain the most common cause of mortality in critically ill patients 4 . Recent studies have linked histones to the proposed pathogenesis of these disorders by associating the levels of circulating histones with severity of illness 5,6 .…”

Unrecognized liver injury assessed by fibrosis indexes is associated with mortality in critically ill COVID-19 patients

“…The mortality rate of patients in which liver fibrosis indexes could not be calculated was similar to that in the rest of the cohort (Supplementary table 1). [20,21] and has been associated with poorer outcomes in chronic liver disease [22]; furthermore, the APACHE II is a widely validated score for the assessment of prognosis in critically ill patients, including those with acute respiratory failure and ARDS as a primary cause of admission [23,24]. Our findings confirm a recent report indicating that the severity of COVID-19 was significantly less intense in patients with a low risk of the fibrosis FIB-4 category as compared with those with intermediate or high fibrosis categories [8].…”