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

Catherine L Auriemma^{1

2}, Hanjing Zhuo³, Kevin Delucchi⁴, Thomas Deiss⁵, Tom Liu⁶, Alejandra Jauregui⁷, Serena Ke⁸, Kathryn Vessel⁷, Matthew Lippi⁹, Eric Seeley¹⁰, Kirsten N Kangelaris⁷, Antonio Gomez⁸, Carolyn Hendrickson⁸, Kathleen D Liu^{11

12}, Michael A Matthay^{3

10

12}, Lorraine B Ware¹³, Carolyn S Calfee^{3

10

12}

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 839 W. Gates, 3600 Spruce Street, Philadelphia, PA, 19103-4283, USA. Catherine.auriemma@pennmedicine.upenn.edu.
² Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA. Catherine.auriemma@pennmedicine.upenn.edu.
³ Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
⁴ Department of Psychiatry, University of California, San Francisco, USA.
⁵ Department of Biochemistry and Biophysics, University of California, San Francisco, USA.
⁶ Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
⁷ Department of Medicine, University of California, San Francisco, USA.
⁸ Department of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA.
⁹ University of Colorado School of Medicine, Aurora, CO, USA.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA.
¹¹ Division of Nephrology, Department of Medicine, University of California, San Francisco, USA.
¹² Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA.
¹³ Departments of Medicine and Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.

PMID: 32206845
PMCID: PMC7224051
DOI: 10.1007/s00134-020-06010-9

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

Catherine L Auriemma et al. Intensive Care Med. 2020 Jun.

. 2020 Jun;46(6):1222-1231.

doi: 10.1007/s00134-020-06010-9. Epub 2020 Mar 23.

Authors

Affiliations

¹ Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 839 W. Gates, 3600 Spruce Street, Philadelphia, PA, 19103-4283, USA. Catherine.auriemma@pennmedicine.upenn.edu.
² Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA. Catherine.auriemma@pennmedicine.upenn.edu.
³ Cardiovascular Research Institute, University of California, San Francisco, CA, USA.
⁴ Department of Psychiatry, University of California, San Francisco, USA.
⁵ Department of Biochemistry and Biophysics, University of California, San Francisco, USA.
⁶ Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
⁷ Department of Medicine, University of California, San Francisco, USA.
⁸ Department of Pulmonary and Critical Care Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, USA.
⁹ University of Colorado School of Medicine, Aurora, CO, USA.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, USA.
¹¹ Division of Nephrology, Department of Medicine, University of California, San Francisco, USA.
¹² Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA.
¹³ Departments of Medicine and Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.

PMID: 32206845
PMCID: PMC7224051
DOI: 10.1007/s00134-020-06010-9

Abstract

Purpose: 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.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Mortality; Sepsis.

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

**Fig. 1**
Study flowcharts for the EARLI and VALID cohorts

**Fig. 2**
Odds ratios with 95% confidence intervals for in-hospital mortality stratified by severity of ARDS. In addition to severity of illness variables listed in the table, adjusted models for EARLI include age, limitation on code status at admission, and being admitted from a nursing home. Adjusted models for VALID include age

See this image and copyright information in PMC

Comment in

The attributable mortality of acute respiratory distress syndrome.
de Grooth HJ, Tuinman PR, Girbes ARJ. de Grooth HJ, et al. Intensive Care Med. 2020 Jul;46(7):1508-1509. doi: 10.1007/s00134-020-06053-y. Epub 2020 Apr 27. Intensive Care Med. 2020. PMID: 32338308 No abstract available.
The attributable mortality of acute respiratory distress syndrome.
Auriemma CL, Delucchi K, Liu KD, Calfee CS. Auriemma CL, et al. Intensive Care Med. 2020 Jul;46(7):1510-1511. doi: 10.1007/s00134-020-06099-y. Epub 2020 May 25. Intensive Care Med. 2020. PMID: 32451576 Free PMC article. No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical