Drug-associated acute lung injury: A population-based cohort study

Rajanigandha Dhokarh, Guangxi Li, Christopher N. Schmickl, Rahul Kashyap, Jyoti Assudani, Andrew Harold Limper, Ognjen Gajic

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: A number of drugs have been reported as risk factors for acute lung injury (ALI) and ARDS. However, evidence is largely limited to case reports, and there is a paucity of data on the incidence and outcome of drug-associated ALI (DALI). Methods: Using a population-based retrospective cohort study design, critically ill patients with a diagnosis of ALI were studied. These patients were classified as having DALI or non-DALI, based on whether they were exposed to prespecified drugs prior to development of ALI. Outcomes were compared between the two groups and frequencies and incidences reported. Results: Among 514 patients with ALI, 49 (9.5%) had DALI with an estimated population-based incidence of 6.6 (95% CI, 4.8-8.5) per 100,000 person-years. Of the 49 patients with DALI, 36 received chemotherapeutic/ antiinflammatory agents, and 14 received amiodarone. Twelve patients had no additional risk factors for ALI (probable DALI), whereas 37 had alternative risk factors (possible DALI). Patients with and without DALI had similar baseline characteristics. However, the APACHE (Acute Physiology and Chronic Health Evaluation) III scores (median, 83 vs 70, P = .03), ICU mortality (35% vs 20%, P = .03), and hospital mortality (63% vs 32%, P < .001) were significantly higher in the DALI group compared with those of the non-DALI group. Hospital mortality remained significantly higher after adjusting for APACHE III score on admission and the presence of malignancy in logistic regression analysis (OR, 2.8; 95% CI, 1.3-6.4; P = .009). Conclusions: Drugs are important risk factors for ALI, and recognizing them as such may have important implications for early identification of patients at risk, discontinuation of the offending agent, and prognosis.

Original languageEnglish (US)
Pages (from-to)845-850
Number of pages6
JournalChest
Volume142
Issue number4
DOIs
StatePublished - Oct 2012

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Acute Lung Injury
Cohort Studies
Pharmaceutical Preparations
Population
APACHE
Hospital Mortality
Incidence
Amiodarone
Critical Illness
Anti-Inflammatory Agents
Retrospective Studies
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Dhokarh, R., Li, G., Schmickl, C. N., Kashyap, R., Assudani, J., Limper, A. H., & Gajic, O. (2012). Drug-associated acute lung injury: A population-based cohort study. Chest, 142(4), 845-850. https://doi.org/10.1378/chest.11-2103

Drug-associated acute lung injury : A population-based cohort study. / Dhokarh, Rajanigandha; Li, Guangxi; Schmickl, Christopher N.; Kashyap, Rahul; Assudani, Jyoti; Limper, Andrew Harold; Gajic, Ognjen.

In: Chest, Vol. 142, No. 4, 10.2012, p. 845-850.

Research output: Contribution to journalArticle

Dhokarh, R, Li, G, Schmickl, CN, Kashyap, R, Assudani, J, Limper, AH & Gajic, O 2012, 'Drug-associated acute lung injury: A population-based cohort study', Chest, vol. 142, no. 4, pp. 845-850. https://doi.org/10.1378/chest.11-2103
Dhokarh R, Li G, Schmickl CN, Kashyap R, Assudani J, Limper AH et al. Drug-associated acute lung injury: A population-based cohort study. Chest. 2012 Oct;142(4):845-850. https://doi.org/10.1378/chest.11-2103
Dhokarh, Rajanigandha ; Li, Guangxi ; Schmickl, Christopher N. ; Kashyap, Rahul ; Assudani, Jyoti ; Limper, Andrew Harold ; Gajic, Ognjen. / Drug-associated acute lung injury : A population-based cohort study. In: Chest. 2012 ; Vol. 142, No. 4. pp. 845-850.
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abstract = "Background: A number of drugs have been reported as risk factors for acute lung injury (ALI) and ARDS. However, evidence is largely limited to case reports, and there is a paucity of data on the incidence and outcome of drug-associated ALI (DALI). Methods: Using a population-based retrospective cohort study design, critically ill patients with a diagnosis of ALI were studied. These patients were classified as having DALI or non-DALI, based on whether they were exposed to prespecified drugs prior to development of ALI. Outcomes were compared between the two groups and frequencies and incidences reported. Results: Among 514 patients with ALI, 49 (9.5{\%}) had DALI with an estimated population-based incidence of 6.6 (95{\%} CI, 4.8-8.5) per 100,000 person-years. Of the 49 patients with DALI, 36 received chemotherapeutic/ antiinflammatory agents, and 14 received amiodarone. Twelve patients had no additional risk factors for ALI (probable DALI), whereas 37 had alternative risk factors (possible DALI). Patients with and without DALI had similar baseline characteristics. However, the APACHE (Acute Physiology and Chronic Health Evaluation) III scores (median, 83 vs 70, P = .03), ICU mortality (35{\%} vs 20{\%}, P = .03), and hospital mortality (63{\%} vs 32{\%}, P < .001) were significantly higher in the DALI group compared with those of the non-DALI group. Hospital mortality remained significantly higher after adjusting for APACHE III score on admission and the presence of malignancy in logistic regression analysis (OR, 2.8; 95{\%} CI, 1.3-6.4; P = .009). Conclusions: Drugs are important risk factors for ALI, and recognizing them as such may have important implications for early identification of patients at risk, discontinuation of the offending agent, and prognosis.",
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