Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock

被引：62

作者：

Fujishima, Seitaro ^{[1
]}

Gando, Satoshi ^{[6
]}

Daizoh, Saitoh ^{[7
]}

Kushimoto, Shigeki ^{[8
]}

Ogura, Hiroshi ^{[9
]}

Mayumi, Toshihiko ^{[10
]}

Takuma, Kiyotsugu ^{[11
]}

Kotani, Joji ^{[12
]}

Yamashita, Norio ^{[13
]}

Tsuruta, Ryosuke ^{[15
]}

Takeyama, Naoshi ^{[16
]}

Shiraishi, Shin-ichiro ^{[3
]}

Araki, Tsunetoshi ^{[14
]}

Suzuki, Koichiro ^{[17
]}

Ikeda, Hiroto ^{[4
]}

Miki, Yasuo ^{[18
]}

Suzuki, Yasushi ^{[19
]}

Yamaguchi, Yoshihiro ^{[5
]}

Aikawa, Naoki ^{[2
]}

机构：

[1] Keio Univ, Sch Med, Ctr Gen Med Educ, Tokyo, Japan

[2] Keio Univ, Sch Med, Dept Emergency & Crit Care Med, Tokyo, Japan

[3] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan

[4] Teikyo Univ, Sch Med, Dept Emergency Med, Trauma & Resuscitat Ctr, Tokyo, Japan

[5] Kyorin Univ, Sch Med, Dept Trauma & Crit Care Med, Tokyo, Japan

[6] Hokkaido Univ, Grad Sch Med, Div Acute & Crit Care Med, Dept Anesthesiol & Crit Care Med, Sapporo, Hokkaido, Japan

[7] Natl Def Med Coll, Res Inst, Div Traumatol, Tokorozawa, Saitama, Japan

[8] Tohoku Univ, Grad Sch Med, Div Emergency Med, Sendai, Miyagi, Japan

[9] Osaka Univ, Grad Sch Med, Dept Traumatol & Acute Crit Med, Osaka, Japan

[10] Univ Occupat & Environm Hlth, Dept Emergency Med, Kitakyushu, Fukuoka, Japan

[11] Kawasaki Municipal Hosp, Emergency Crit Care Ctr, Kawasaki, Kanagawa, Japan

[12] Hyogo Coll Med, Dept Emergency Crit Care & Disaster Med, Nishinomiya, Hyogo, Japan

[13] Kurume Univ, Sch Med, Dept Emergency & Crit Care Med, Kurume, Fukuoka, Japan

[14] St Marys Hosp, Ctr Trauma, Dept Emergency & Crit Care Med, Kurume, Fukuoka, Japan

[15] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Yamaguchi, Japan

[16] Fujita Hlth Univ, Dept Emergency & Acute Intens Care Med, Toyoake, Aichi, Japan

[17] Kawasaki Med Sch, Dept Acute Med, Kurashiki, Okayama, Japan

[18] Aichi Med Univ Hosp, Adv Crit Care Ctr, Nagakute, Aichi, Japan

[19] Iwate Med Univ, Dept Crit Care Med, Morioka, Iwate, Japan

来源：

RESPIROLOGY | 2016年 / 21卷 / 05期

关键词：

acute lung injury; acute respiratory distress syndrome; disseminated intravascular coagulation; multiple organ dysfunction syndrome; severe sepsis; JAPANESE ASSOCIATION; SURVIVING SEPSIS; MORTALITY; IMPLEMENTATION; DEFINITIONS; MULTICENTER; BUNDLE; CARE; ARDS;

D O I：

10.1111/resp.12769

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

Background and objectiveSepsis is a leading cause of acute lung injury (ALI); however, the characteristics and outcome of sepsis-associated ALI are poorly understood. We aimed to elucidate factors that predict patient outcome in sepsis-associated ALI. MethodsSecondary analysis of a multicenter, prospective, observational study was performed. ResultsAmong 624 patients with severe sepsis and septic shock, 251 (40.2%) fulfilled the definition of American-European Consensus Conference definition of ALI. All-cause 28-day and in-hospital mortalities were 30.7% and 38.6%, respectively. More than 40% of ALI patients had neurological, cardiovascular and haematological dysfunctions or disseminated intravascular coagulation, all of which were associated with higher mortality. We report a significant correlation between infection site and mortality in patients with ALI, but not in those without ALI. The proportion of ALI was significantly higher in pulmonary sepsis; further, a complication of ALI was associated with higher mortality in sepsis from pulmonary and other sources, but not in abdominal sepsis. Among the other sepsis sites, urinary tract, central nervous system, catheter-related and undetermined foci of infection had worse outcomes when associated with ALI. None of the individual severe sepsis bundles, including fluid resuscitation and early antibiotic administration, correlated with mortality. Compliance with a set of sepsis management bundles was associated with better outcomes. ConclusionIn severe sepsis and septic shock, the proportion and effect on outcome was not uniform among infection sites. The infection site was predictive of outcome in patients with ALI but not in those without ALI. Using a secondary analysis of a prospective multicenter study for severe sepsis and septic shock, the infection site was found to be an independent prognostic factor together with organ dysfunctions for septic patients with acute lung injury (ALI) but not for those without ALI.

引用

页码：898 / 904

页数：7

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