Risk modifiers of acute respiratory distress syndrome in patients with non-pulmonary sepsis: a retrospective analysis of the FORECAST study

Abstract

Background: Predisposing conditions and risk modifiers instead of causes and risk factors have recently been used as alternatives to identify patients at a risk of acute respiratory distress syndrome (ARDS). However, data regarding risk modifiers among patients with non-pulmonary sepsis is rare. Methods: We conducted a secondary analysis of the multicenter, prospective, Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) cohort study that was conducted in 59 intensive care units (ICUs) in Japan during January 2016-March 2017. Adult patients with severe sepsis caused by non-pulmonary infection were included, and the primary outcome was having ARDS, defined as meeting the Berlin definition on the first or fourth day of screening. Multivariate logistic regression modeling was used to identify risk modifiers associated with ARDS, and odds ratios (ORs) and their 95% confidence intervals were reported. The following explanatory variables were then assessed: age, sex, admission source, body mass index, smoking status, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, steroid use, statin use, infection site, septic shock, and acute physiology and chronic health evaluation (APACHE) II score. Results: After applying inclusion and exclusion criteria, 594 patients with non-pulmonary sepsis were enrolled, among whom 85 (14.3%) had ARDS. Septic shock was diagnosed in 80% of patients with ARDS and 66% of those without ARDS (p = 0.01). APACHE II scores were higher in patients with ] than in those without , p < 0.01]. In the multivariate logistic regression model, the following were independently associated with ARDS:

Possible Predictive Factor of Acute Respiratory Distress Syndrome Development After Mild Traumatic Brain Injury: A Single Rural Trauma Center Preliminary Study

“…Our study found that mild TBI patients diagnosed with sepsis were drastically more likely to develop ARDS than those patients who did not exhibit sepsis (8.8% vs. 0.7%, p = 0.003). Iriyama et al showed soft tissue infection and ICU admission were the possible risk modifier of ARDS in patient with sepsis [ 21 ]. In our study, ICU admission was not noted to be a significant risk factor of sepsis.…”

The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview

“…Likewise, patients with Covid-19 pneumonia who develop ARDS are significantly older than those who do not (16). However, in a recent study by Iriyama et al, there was no significant difference between the mean age of patients who developed ARDS following non-pulmonary sepsis and those who did not (32). Similarly, the age of patients who developed ARDS did not vary significantly from those who did not following out-of-hospital cardiac arrest (33), neutropenia after hematologic malignancy (34), or kidney transplant (35).…”

Clinical and Therapeutic Aspects of Viral Ocular Pathology in Brazzaville

“…Ophthalmic shingles with a rash following dermatoma V1, pseudodendritic keratitis, acute hypertensive anterior uveitis sometimes with iris atrophy Herpes Simplex Primary infection with the presence of a palpebral rash with a ''bouquet of flowers'' aspect, dendritic keratitis CMV Chorioretinitis with retinal hemorrhage giving the appearance of ''Cheese on Ketchup'' in a patient with HIV and having a CD4 lymphocyte count below 50/mm 3…”

“…Medical virology has become particularly important in the past 30 years with the onset of the HIV / AIDS pandemic, recurrent episodes of fevers due to hemorrhagic viruses in Africa, and various outbreaks of SARS (severe acute respiratory syndrome) cases in Asia [1][2][3]. Once in the body, some of these viruses have an eye tropism.…”