The influence of infection sites on development and mortality of ARDS

Chau Chyun Sheu, Michelle Ng Gong, Rihong Zhai, Ednan K. Bajwa, Feng Chen, B. Taylor Thompson, David C. Christiani

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients. Design: Prospective observational study. Setting: Adult intensive care units (ICUs) of an academic medical center. Patients: Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During followup, 549 patients developed ARDS and 212 of them died within 60 days. Main results: The distribution of infection sites in ARDS patients was: lung (77.2%), abdomen (19.3%), skin/soft tissues (6.0%), urinary tract (4.7%), unknown (2.6%), and multiple sites (17.7%). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection. Conclusions: In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.

Original languageEnglish (US)
Pages (from-to)963-970
Number of pages8
JournalIntensive Care Medicine
Volume36
Issue number6
DOIs
StatePublished - Jun 2010

Fingerprint

Adult Respiratory Distress Syndrome
Mortality
Infection
Lung
Odds Ratio
Urinary Tract
Critical Illness
Intensive Care Units
Skin
Bacteremia
Abdomen
Observational Studies
Sepsis
Pneumonia

Keywords

  • Acute respiratory distress syndrome
  • Epidemiology
  • Infection
  • Mortality
  • Pneumonia
  • Risk factors

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Sheu, C. C., Gong, M. N., Zhai, R., Bajwa, E. K., Chen, F., Thompson, B. T., & Christiani, D. C. (2010). The influence of infection sites on development and mortality of ARDS. Intensive Care Medicine, 36(6), 963-970. https://doi.org/10.1007/s00134-010-1851-3

The influence of infection sites on development and mortality of ARDS. / Sheu, Chau Chyun; Gong, Michelle Ng; Zhai, Rihong; Bajwa, Ednan K.; Chen, Feng; Thompson, B. Taylor; Christiani, David C.

In: Intensive Care Medicine, Vol. 36, No. 6, 06.2010, p. 963-970.

Research output: Contribution to journalArticle

Sheu, CC, Gong, MN, Zhai, R, Bajwa, EK, Chen, F, Thompson, BT & Christiani, DC 2010, 'The influence of infection sites on development and mortality of ARDS', Intensive Care Medicine, vol. 36, no. 6, pp. 963-970. https://doi.org/10.1007/s00134-010-1851-3
Sheu, Chau Chyun ; Gong, Michelle Ng ; Zhai, Rihong ; Bajwa, Ednan K. ; Chen, Feng ; Thompson, B. Taylor ; Christiani, David C. / The influence of infection sites on development and mortality of ARDS. In: Intensive Care Medicine. 2010 ; Vol. 36, No. 6. pp. 963-970.
@article{ec35b51d74894d94b18f2343c498e181,
title = "The influence of infection sites on development and mortality of ARDS",
abstract = "Objective: Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients. Design: Prospective observational study. Setting: Adult intensive care units (ICUs) of an academic medical center. Patients: Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During followup, 549 patients developed ARDS and 212 of them died within 60 days. Main results: The distribution of infection sites in ARDS patients was: lung (77.2{\%}), abdomen (19.3{\%}), skin/soft tissues (6.0{\%}), urinary tract (4.7{\%}), unknown (2.6{\%}), and multiple sites (17.7{\%}). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection. Conclusions: In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.",
keywords = "Acute respiratory distress syndrome, Epidemiology, Infection, Mortality, Pneumonia, Risk factors",
author = "Sheu, {Chau Chyun} and Gong, {Michelle Ng} and Rihong Zhai and Bajwa, {Ednan K.} and Feng Chen and Thompson, {B. Taylor} and Christiani, {David C.}",
year = "2010",
month = "6",
doi = "10.1007/s00134-010-1851-3",
language = "English (US)",
volume = "36",
pages = "963--970",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "6",

}

TY - JOUR

T1 - The influence of infection sites on development and mortality of ARDS

AU - Sheu, Chau Chyun

AU - Gong, Michelle Ng

AU - Zhai, Rihong

AU - Bajwa, Ednan K.

AU - Chen, Feng

AU - Thompson, B. Taylor

AU - Christiani, David C.

PY - 2010/6

Y1 - 2010/6

N2 - Objective: Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients. Design: Prospective observational study. Setting: Adult intensive care units (ICUs) of an academic medical center. Patients: Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During followup, 549 patients developed ARDS and 212 of them died within 60 days. Main results: The distribution of infection sites in ARDS patients was: lung (77.2%), abdomen (19.3%), skin/soft tissues (6.0%), urinary tract (4.7%), unknown (2.6%), and multiple sites (17.7%). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection. Conclusions: In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.

AB - Objective: Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients. Design: Prospective observational study. Setting: Adult intensive care units (ICUs) of an academic medical center. Patients: Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During followup, 549 patients developed ARDS and 212 of them died within 60 days. Main results: The distribution of infection sites in ARDS patients was: lung (77.2%), abdomen (19.3%), skin/soft tissues (6.0%), urinary tract (4.7%), unknown (2.6%), and multiple sites (17.7%). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection. Conclusions: In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.

KW - Acute respiratory distress syndrome

KW - Epidemiology

KW - Infection

KW - Mortality

KW - Pneumonia

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=77954455662&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954455662&partnerID=8YFLogxK

U2 - 10.1007/s00134-010-1851-3

DO - 10.1007/s00134-010-1851-3

M3 - Article

C2 - 20229040

AN - SCOPUS:77954455662

VL - 36

SP - 963

EP - 970

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 6

ER -