The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis - PubMed (original) (raw)

Observational Study

The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis

Mark E Mikkelsen et al. Shock. 2013 Nov.

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis, and sepsis-associated ARDS is associated with significant morbidity and mortality. To date, no study has directly examined the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the emergency department (ED).

Methods: This was a single-center retrospective, observational cohort study of 778 adults with severe sepsis presenting to the ED. The primary outcome was the development of ARDS requiring mechanical ventilation during the first 5 hospital days. Acute respiratory distress syndrome was defined using the Berlin definition. We used multivariable logistic regression to identify risk factors associated independently with ARDS development.

Results: The incidence of ARDS was 6.2% (48/778 patients) in the entire cohort. Acute respiratory distress syndrome development varied across the continuum of care: 0.9% of patients fulfilled criteria for ARDS in the ED, 1.4% admitted to the ward developed ARDS, and 8.9% admitted to the intensive care unit developed ARDS. Acute respiratory distress syndrome developed a median of 1 day after admission and was associated with a 4-fold higher risk of in-hospital mortality (14% vs. 60%, P < 0.001). Independent risk factors associated with increased risk of ARDS development included intermediate (2-3.9 mmol/L) (P = 0.04) and high (≥4) serum lactate levels (P = 0.008), Lung Injury Prediction score (P < 0.001), and microbiologically proven infection (P = 0.01).

Conclusions: In patients presenting to the ED with severe sepsis, the rate of sepsis-associated ARDS development varied across the continuum of care. Acute respiratory distress syndrome developed rapidly and was associated with significant mortality. Elevated serum lactate levels in the ED and a recently validated clinical prediction score were independently associated with the development of ARDS in severe sepsis.

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Conflict of interest statement

Disclosures: For each of the above authors, no financial or other potential conflicts of interest exist related to this work. Presented as an abstract at the American Thoracic Society International Conference, May 2009, San Diego, California.

Figures

Figure 1

Enrollment and outcomes (ARDS) for severe sepsis cohort.

Figure 2

The incidence of ARDS by initial serum lactate level measured in the emergency department. The incidence and upper bound of the 95% confidence interval are presented by categorized serum lactate levels. Serum lactate categorized as: Low = 0 – 1.9 mmol/L, Intermediate = 2 – 3.9 mmol/L, and High = ≥4 mmol/L.

Figure 3

Fitted relationship between serum lactate levels and predicted probability of ARDS, using a fractional polynomial regression model.

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The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis - PubMed (original) (raw)