Md. Zilberberg et Sk. Epstein, ACUTE LUNG INJURY IN THE MEDICAL ICU - COMORBID CONDITIONS, AGE, ETIOLOGY, AND HOSPITAL OUTCOME, American journal of respiratory and critical care medicine, 157(4), 1998, pp. 1159-1164
Citations number
36
Categorie Soggetti
Emergency Medicine & Critical Care","Respiratory System
The independent effects of chronic disease, age, severity of illness,
lung injury score (LIS) and etiology, and preceding nonpulmonary organ
-system dysfunction (OSD) on the outcome of acute lung injury (ALI) ha
ve not been examined in an exclusively medical-intensive-care-unit (MI
CU) population. Therefore, 107 consecutive MICU patients with ALI (76%
with acute respiratory distress syndrome [ARDS]) were prospectively i
nvestigated. The impact of comorbidities, age > 65 yr, acute physiolog
y score (APS), LIS, etiology of ALI, and OSD on hospital survival were
studied. The overall mortality was 62 of 107 patients (58%), includin
g 47 (58%) with ARDS. With univariate analysis, age > 65 yr, organ tra
nsplantation, human immunodeficiency virus (HIV) infection, active mal
ignancy, chronic steroid use, and a septic or aspiration-related etiol
ogy of ALI were associated with a greater than or equal to 1.2-fold gr
eater relative risk (RR) of hospital mortality. With multiple logistic
regression, independent predictors of hospital death were age > 65 yr
, organ transplantation, HIV infection, cirrhosis, active malignancy,
and sepsis. APS, LIS, aspiration-related etiology of ALI, preceding OS
D, and other comorbidities were not independently predictive of hospit
al death. Multivariate analysis of the ARDS cohort showed similar resu
lts, although cirrhosis and malignancy did not reach statistical signi
ficance. We conclude that comorbid conditions, older age, and sepsis e
tiology are independent predictors of hospital death in exclusively MI
CU patients with ALI (76% of whom satisfied criteria for ARDS). These
factors should be considered in analyzing studies of new therapies and
interpreting trends in mortality for ALI and ARDS.