Risk factors for the development of acute lung injury in patients with infectious pneumonia

Marija Kojicic, Guangxi Li, Andrew C. Hanson, Kun Moo Lee, Lokendra Thakur, Jayanth Vedre, Adil Ahmed, Larry M. Baddour, Jay H Ryu, Ognjen Gajic

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Abstract

Introduction: Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia.Methods: A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner.Results: The study included 596 patients; 365 (61.2%) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7%) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24%) compared with viral (n = 19 of 55, 35%), fungal (n = 39 of 95, 41%), and mixed isolates pneumonias (n = 14 of 34, 41%; P = 0.002). After adjusting for baseline severity of illness and comorbidities, patients in whom ALI developed had a markedly increased risk of hospital death (OR adj 9.7; 95% CI, 6.0 to 15.9). In a nested case-control study, presence of shock (OR, 8.9; 95% CI, 2.8 to 45.9), inappropriate initial antimicrobial treatment (OR, 3.2; 95% CI, 1.3 to 8.5), and transfusions (OR, 4.8; 95% CI, 1.5 to 19.6) independently predicted ALI development.Conclusions: The development of ALI among patients hospitalized with infectious pneumonia varied among pulmonary pathogens and was associated with increased mortality. Inappropriate initial antimicrobial treatment and transfusion predict the development of ALI independent of pathogen.

Original languageEnglish (US)
Article numberR46
JournalCritical Care
Volume16
Issue number2
DOIs
StatePublished - Mar 14 2012

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Acute Lung Injury
Pneumonia
Adult Respiratory Distress Syndrome
Case-Control Studies
Comorbidity
Shock
Cohort Studies
Retrospective Studies
Lung
Mortality

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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Risk factors for the development of acute lung injury in patients with infectious pneumonia. / Kojicic, Marija; Li, Guangxi; Hanson, Andrew C.; Lee, Kun Moo; Thakur, Lokendra; Vedre, Jayanth; Ahmed, Adil; Baddour, Larry M.; Ryu, Jay H; Gajic, Ognjen.

In: Critical Care, Vol. 16, No. 2, R46, 14.03.2012.

Research output: Contribution to journalArticle

Kojicic, M, Li, G, Hanson, AC, Lee, KM, Thakur, L, Vedre, J, Ahmed, A, Baddour, LM, Ryu, JH & Gajic, O 2012, 'Risk factors for the development of acute lung injury in patients with infectious pneumonia', Critical Care, vol. 16, no. 2, R46. https://doi.org/10.1186/cc11247
Kojicic, Marija ; Li, Guangxi ; Hanson, Andrew C. ; Lee, Kun Moo ; Thakur, Lokendra ; Vedre, Jayanth ; Ahmed, Adil ; Baddour, Larry M. ; Ryu, Jay H ; Gajic, Ognjen. / Risk factors for the development of acute lung injury in patients with infectious pneumonia. In: Critical Care. 2012 ; Vol. 16, No. 2.
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abstract = "Introduction: Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia.Methods: A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner.Results: The study included 596 patients; 365 (61.2{\%}) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7{\%}) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24{\%}) compared with viral (n = 19 of 55, 35{\%}), fungal (n = 39 of 95, 41{\%}), and mixed isolates pneumonias (n = 14 of 34, 41{\%}; P = 0.002). After adjusting for baseline severity of illness and comorbidities, patients in whom ALI developed had a markedly increased risk of hospital death (OR adj 9.7; 95{\%} CI, 6.0 to 15.9). In a nested case-control study, presence of shock (OR, 8.9; 95{\%} CI, 2.8 to 45.9), inappropriate initial antimicrobial treatment (OR, 3.2; 95{\%} CI, 1.3 to 8.5), and transfusions (OR, 4.8; 95{\%} CI, 1.5 to 19.6) independently predicted ALI development.Conclusions: The development of ALI among patients hospitalized with infectious pneumonia varied among pulmonary pathogens and was associated with increased mortality. Inappropriate initial antimicrobial treatment and transfusion predict the development of ALI independent of pathogen.",
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AU - Kojicic, Marija

AU - Li, Guangxi

AU - Hanson, Andrew C.

AU - Lee, Kun Moo

AU - Thakur, Lokendra

AU - Vedre, Jayanth

AU - Ahmed, Adil

AU - Baddour, Larry M.

AU - Ryu, Jay H

AU - Gajic, Ognjen

PY - 2012/3/14

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N2 - Introduction: Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia.Methods: A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner.Results: The study included 596 patients; 365 (61.2%) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7%) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24%) compared with viral (n = 19 of 55, 35%), fungal (n = 39 of 95, 41%), and mixed isolates pneumonias (n = 14 of 34, 41%; P = 0.002). After adjusting for baseline severity of illness and comorbidities, patients in whom ALI developed had a markedly increased risk of hospital death (OR adj 9.7; 95% CI, 6.0 to 15.9). In a nested case-control study, presence of shock (OR, 8.9; 95% CI, 2.8 to 45.9), inappropriate initial antimicrobial treatment (OR, 3.2; 95% CI, 1.3 to 8.5), and transfusions (OR, 4.8; 95% CI, 1.5 to 19.6) independently predicted ALI development.Conclusions: The development of ALI among patients hospitalized with infectious pneumonia varied among pulmonary pathogens and was associated with increased mortality. Inappropriate initial antimicrobial treatment and transfusion predict the development of ALI independent of pathogen.

AB - Introduction: Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia.Methods: A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner.Results: The study included 596 patients; 365 (61.2%) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7%) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24%) compared with viral (n = 19 of 55, 35%), fungal (n = 39 of 95, 41%), and mixed isolates pneumonias (n = 14 of 34, 41%; P = 0.002). After adjusting for baseline severity of illness and comorbidities, patients in whom ALI developed had a markedly increased risk of hospital death (OR adj 9.7; 95% CI, 6.0 to 15.9). In a nested case-control study, presence of shock (OR, 8.9; 95% CI, 2.8 to 45.9), inappropriate initial antimicrobial treatment (OR, 3.2; 95% CI, 1.3 to 8.5), and transfusions (OR, 4.8; 95% CI, 1.5 to 19.6) independently predicted ALI development.Conclusions: The development of ALI among patients hospitalized with infectious pneumonia varied among pulmonary pathogens and was associated with increased mortality. Inappropriate initial antimicrobial treatment and transfusion predict the development of ALI independent of pathogen.

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