Background
Importance
Goal of this investigation
Methods
Study design
Study setting
Selection of participants
Data collection and processing
Outcome measures
Primary data analysis
Sensitivity analysis
Results and discussion
Results
Characteristic of study subjects
ALI Developed within 48 H of Admission in At-Risk Patients and Markedly Increased Mortality
Variable | Total (n = 4361) | No ALI (n = 4058) | ALI (n = 303) | OR (95 % CI) | P-value |
---|---|---|---|---|---|
Demographics
| |||||
Median age (Q1, Q3) | 56.0 (41.0, 71.0) | 56.0 (41.0, 71.0) | 54.0 (41.0, 67.0) | 0.99 (0.99, 1.00) | 0.050 |
Male, no. (%) | 2,422 (55.5 %) | 2222 (54.8 %) | 200 (66.0 %) | 1.60 (1.26, 2.05) | < 0.001 |
Caucasian (n = 4220), no. (%), | 2608 (61.8 %) | 2424 (61.8 %) | 184 (62.0 %) | 1.01 (0.79, 1.28) | 0.956 |
Weight (n = 3905), median (Q1, Q3) | 76.5 (63.5, 91.0) | 76.0 (63.5, 91.0) | 83.2 (69.2, 96.0) | 1.84 (1.43, 2.37) | < 0.001 |
PBW(n = 3551), median (Q1, Q3) | 63.8 (64.7, 73.0) | 63.8 (54.6, 73.0) | 66.1 (56.4, 75.0) | 1.42 (1.10, 1.84) | 0.007 |
Admission source (n = 4311), no. (%) | |||||
Home | 3,331 (77.3 %) | 3,125 (78.0 %) | 206 (68.2 %) | 1.00 | |
Nursing facility | 338 (7.8 %) | 322 (8.0 %) | 16 (5.3 %) | 0.75 (0.45, 1.27) | 0.002 |
Outside ED | 440 (10.2 %) | 396 (9.9 %) | 44 (14.6 %) | 1.69 (1.20, 2.37) | 0.253 |
Other | 202 (4.7 %) | 166 (4.1 %) | 36 (11.9 %) | 3.29 (2.23, 4.84) | < 0.001 |
APACHE II (Q1, Q3) | 10.0 (6.0, 15.0) | 9.0 (5.0, 14.0) | 15.0 (10.0, 21.0) | 1.11 (1.09, 1.13) | < 0.001 |
Predisposing conditions
| |||||
Shock | 395 (9.1 %) | 327 (8.1 %) | 68 (22.4 %) | 3.30 (2.46, 4.42) | < 0.001 |
Aspiration | 210 (4.8 %) | 176 (4.3 %) | 34 (1.2 %) | 2.79 (1.89, 4.11) | < 0.001 |
Sepsis | 1,806 (41.4 %) | 1,684 (41.5 %) | 122 (40.3 %) | 0.95 (0.75, 1.21) | 0.674 |
Pancreatitis | 323 (7.4 %) | 314 (7.7 %) | 9 (3.0 %) | 0.37 (0.19, 0.72) | 0.003 |
Pneumonia | 1,227 (28.1 %) | 1,127 (27.8 %) | 100 (33.0 %) | 1.28 (0.99, 1.64) | 0.051 |
High-risk trauma | |||||
Traumatic brain injury | 490 (11.2 %) | 445 (11.0 %) | 45 (14.9 %) | 1.42 (1.02, 1.97) | 0.040 |
Smoke inhalation | 27 (0.6 %) | 20 (0.5 %) | 7 (2.3 %) | 4.78 (2.00, 11.38) | < 0.001 |
Near drowning | 3 (0.1 %) | 2 (0.1 %) | 1 (0.3 %) | 6.72 (0.61, 74.27) | 0.120 |
Lung contusion | 188 (4.3 %) | 161 (4.0 %) | 27 (8.9 %) | 2.37 (1.55, 3.63) | < 0.001 |
Multiple fractures | 330 (7.6 %) | 304 (7.5 %) | 26 (8.6 %) | 1.16 (0.76, 1.76) | 0.489 |
High-risk surgery | |||||
Thoracic (noncardiac) | 5 (0.1 %) | 4 (0.1 %) | 1 (0.3 %) | 3.36 (0.37, 30.12) | 0.280 |
Orthopedic spine | 17 (0.4 %) | 13 (0.3 %) | 4 (1.3 %) | 4.16 (1.35, 12.85) | 0.013 |
Acute abdomen | 295 (6.8 %) | 268 (6.6 %) | 27 (8.9 %) | 1.38 (0.91, 2.09) | 0.125 |
Cardiac surgery | 20 (0.5 %) | 14 (0.3 %) | 6 (2.0 %) | 5.84 (2.23, 15.30) | < 0.001 |
Aortic vascular | 14 (0.3 %) | 8 (0.2 %) | 6 (2.0 %) | 10.23 (3.53, 29.68) | < 0.001 |
Emergency surgery | 339 (7.7 %) | 282 (7.0 %) | 57 (18.8 %) | 3.10 (2.27, 4.24) | < 0.001 |
Risk modifiers
| |||||
Alcohol abuse | 421 (9.7 %) | 381 (9.4 %) | 40 (13.2 %) | 1.47 (1.04, 2.08) | 0.031 |
Obesity (n = 3,508) | 1,020 (29.1 %) | 929 (28.6 %) | 91 (35.0 %) | 1.34 (1.03, 1.75) | 0.029 |
Chemotherapy | 158 (3.6 %) | 145 (3.6 %) | 13 (4.3 %) | 1.21 (0.68, 2.16) | 0.520 |
Diabetes mellitus | 1,042 (23.9 %) | 987 (24.3 %) | 55 (18.2 %) | 0.69 (0.51, 0.93) | 0.016 |
Smoking (n = 4,019) | |||||
None | 2,060 (51.3 %) | 1,931 (51.6 %) | 129 (47.1 %) | 1.00 | -- |
Former | 888 (22.1 %) | 829 (22.1 %) | 59 (21.5 %) | 1.07 (0.78, 1.47) | 0.644 |
Active | 1,071 (26.7 %) | 985 (26.3 %) | 86 (31.4 %) | 1.31 (0.98, 1.74) | 0.089 |
RR (n = 4,137), median (Q1,Q3) | 20.0 (18.0, 24.0) | 20.0 (18.0, 24.0) | 22.0 (18.0, 27.0) | ||
Tachypnea (n = 4,137), no. (%) | 315 (7.6 %) | 269 (6.8 %) | 52 (18.8 %) | 3.18 (2.29, 4.40) | < 0.001 |
SpO2 (n = 4,361), median (Q1, Q3) | 97.0 (94.0, 99.0) | 97.0 (94.0, 99.0) | 95.0 (92.0, 98.0) | ||
SpO2 < 95 % (n = 4,361) | 1,203 (27.6 %) | 1,076 (26.5 %) | 127 (41.9 %) | 2.17 (1.56, 3.02) | < 0.001 |
FiO2 (n = 4,361), median (Q1, Q3) | 0.2 (0.2, 0.3) | 0.2 (0.2, 0.3) | 0.4 (0.2, 1.0) | ||
FiO2 >0.35 (n = 4,796), no. (%) | 841 (19.3 %) | 688 (17.0 %) | 153 (50.5 %) | 4.92 (3.87, 6.25) | < 0.001 |
Albumin (n = 2,423), median (Q1, Q3) | 3.5 (2.9, 4.0) | 3.5 (3.0, 4.0) | 3.2 (2.4, 3.7) | ||
Hypoalbuminemia (n = 2,423), no. (%) | 945 (47.1 %) | 838 (45.6 %) | 107 (64.5 %) | 2.17 (1.56, 3.02) | < 0.001 |
pH (n = 1,499), median (Q1, Q3) | 7.4 (7.3, 7.4) | 7.4 (7.3, 7.4) | 7.3 (7.2, 7.4) | ||
Acidosis (pH <7.35), no. (%) | 476 (45.9 %) | 364 (43.3 %) | 112 (56.6 %) | 1.70 (1.25, 2.33) | < 0.001 |
Variable | Total (n = 4,361) |
No ALI ( n = 4,058) | ALI (n = 303) | OR (95 % CI) | P-value |
---|---|---|---|---|---|
ICU admission, no. (%) | 2,320 (53.2 %) | 2,043 (50.3 %) | 277 (91.4 %) | 10.50 (6.99, 15.77) | < 0.001 |
ICU LOS (n = 2,320), median (Q1, Q3) | 2.0 (1.0, 5.0) | 2.0 (0.0, 4.0) | 9.0 (5.0, 17.0) | 19.12 (9.79, 37.38) | < 0.001 |
Hospital LOS (n = 4361), median (Q1, Q3) | 6.0 (3.0, 10.0) | 5.0 (3.0, 9.0) | 16.0 (9.0, 26.0) | 8.60 (5.94, 12.36) | < 0.001 |
Vasopressors use, no. (%) | 448 (10.3 %) | 334 (8.2 %) | 114 (37.6 %) | 6.73 (5.20, 8.71) | < 0.001 |
Acute hemodialysis (n = 4,290), no. (%) | 148 (3.5 %) | 115 (2.9 %) | 33 (11.0 %) | 4.15 (2.76, 6.23) | < 0.001 |
ICU mortality, no. (%) | 194 (4.5 %) | 120 (3.0 %) | 74 (24.4 %) | 10.61 (7.71, 14.59) | < 0.001 |
Hospital mortality, no. (%) | 272 (6.2 %) | 188 (4.6 %) | 84 (27.7 %) | 7.90 (5.90, 10.56) | < 0.001 |
Mechanical ventilation (n = 4,223) | 1,299 (30.8 %) | 1,013 (25.8 %) | 286 (94.7 %) | 51.29 (30.85, 85.28) | < 0.001 |
Non-invasive (n = 4,146), no. (%) | 470 (11.3 %) | 387 (10.0 %) | 83 (30.1 %) | 3.87 (2.93, 5.11) | < 0.001 |
Non-invasive duration (n = 461), median (Q1, Q3) | 2.0 (1.0, 5.0) | 2.0 (1.0, 5.0) | 3.0 (2.0, 5.5) | 1.29 (0.73, 2.25) | 0.379 |
Invasive (n = 4,228), no. (%) | 997 (23.6 %) | 730 (18.6 %) | 267 (88.4 %) | 33.40 (23.27, 47.94) | < 0.001 |
Invasive duration (n = 932), median (Q1, Q3) | 3.0 (1.0, 8.0) | 2.0 (1.0, 5.0) | 8.0 (4.0, 15.0) | 6.53 (4.52, 9.42) | < 0.001 |
TV/PBW (n = 768), median (Q1, Q3) | 8.3 (7.4, 9.5) | 8.4 (7.5, 9.7) | 8.1 (7.3, 9.2) | 0.70 (0.51, 0.96) | 0.029 |
Plateau pressure (n = 435), median (Q1, Q3) | 19.0 (16.0, 24.0) | 19.0 (15.0, 23.0) | 21.0 (17.0, 27.2) | 1.77 (1.17, 2.69) | 0.007 |
PEEP (n = 916), median (Q1, Q3) | 5.0 (5.0, 5.5) | 5.0 (5.0, 5.0) | 5.0 (5.0, 8.0) | 2.30 (1.32, 4.01) | 0.003 |
Mode: Volume control | 762 (83.9 %) | 561 (86.4 %) | 201 (77.6 %) | 1.00 | -- |
Mode: Pressure control | 111 (12.2 %) | 63 (9.7 %) | 48 (18.5 %) | 2.13 (1.41, 3.20) | 0.010 |