ACUTE LUNG INJURY IN THE MEDICAL ICU - COMORBID CONDITIONS, AGE, ETIOLOGY, AND HOSPITAL OUTCOME

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.