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

Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background and objective: Sepsis 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. Methods: Secondary analysis of a multicenter, prospective, observational study was performed. Results: Among 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. Conclusion: In 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.

Original languageEnglish
Pages (from-to)898-904
Number of pages7
JournalRespirology
Volume21
Issue number5
DOIs
Publication statusPublished - 2016 Jul 1

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Acute Lung Injury
Septic Shock
Sepsis
Infection
Mortality
Lung
Disseminated Intravascular Coagulation
Hospital Mortality
Urinary Tract
Resuscitation
Observational Studies
Catheters
Central Nervous System
Prospective Studies

Keywords

  • acute lung injury
  • acute respiratory distress syndrome
  • disseminated intravascular coagulation
  • multiple organ dysfunction syndrome
  • severe sepsis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group (2016). Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock. Respirology, 21(5), 898-904. https://doi.org/10.1111/resp.12769

Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock. / Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group.

In: Respirology, Vol. 21, No. 5, 01.07.2016, p. 898-904.

Research output: Contribution to journalArticle

Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group 2016, 'Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock', Respirology, vol. 21, no. 5, pp. 898-904. https://doi.org/10.1111/resp.12769
Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group. Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock. Respirology. 2016 Jul 1;21(5):898-904. https://doi.org/10.1111/resp.12769
Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group. / Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock. In: Respirology. 2016 ; Vol. 21, No. 5. pp. 898-904.
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abstract = "Background and objective: Sepsis 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. Methods: Secondary analysis of a multicenter, prospective, observational study was performed. Results: Among 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. Conclusion: In 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.",
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T1 - Infection site is predictive of outcome in acute lung injury associated with severe sepsis and septic shock

AU - Japanese Association for Acute Medicine Sepsis Registry (JAAM SR) Study Group

AU - Fujishima, Seitaro

AU - Gando, Satoshi

AU - Daizoh, Saitoh

AU - Kushimoto, Shigeki

AU - Ogura, Hiroshi

AU - Mayumi, Toshihiko

AU - Takuma, Kiyotsugu

AU - Kotani, Joji

AU - Yamashita, Norio

AU - Tsuruta, Ryosuke

AU - Takeyama, Naoshi

AU - Shiraishi, Shin Ichiro

AU - Araki, Tsunetoshi

AU - Suzuki, Koichiro

AU - Ikeda, Hiroto

AU - Miki, Yasuo

AU - Suzuki, Yasushi

AU - Yamaguchi, Yoshihiro

AU - Aikawa, Naoki

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background and objective: Sepsis 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. Methods: Secondary analysis of a multicenter, prospective, observational study was performed. Results: Among 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. Conclusion: In 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.

AB - Background and objective: Sepsis 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. Methods: Secondary analysis of a multicenter, prospective, observational study was performed. Results: Among 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. Conclusion: In 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.

KW - acute lung injury

KW - acute respiratory distress syndrome

KW - disseminated intravascular coagulation

KW - multiple organ dysfunction syndrome

KW - severe sepsis

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