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Original Research: CRITICAL CARE MEDICINE |

Pulmonary vs Nonpulmonary Sepsis and Mortality in Acute Lung Injury

Jonathan E. Sevransky, MD, MHS, FCCP; Greg S. Martin, MD, MSc, FCCP; Pedro Mendez-Tellez, MD; Carl Shanholtz, MD; Roy Brower, MD; Peter J. Pronovost, MD, PhD; Dale M. Needham, MD, PhD
Author and Funding Information

*From the Division of Pulmonary and Critical Care (Drs. Sevransky, Brower, and Needham), Johns Hopkins Medical Institutions, Baltimore, MD; Division of Pulmonary, Allergy and Critical Care (Dr. Martin), Emory University School of Medicine, Atlanta, GA; Department of Anesthesiology and Critical Care Medicine (Drs. Mendez-Tellez and Pronovost), Johns Hopkins Medical Institutions, Baltimore, MD; and Division of Pulmonary and Critical Care Medicine (Dr. Shanholtz), University of Maryland, Baltimore, MD.

Correspondence to: Jonathan E. Sevransky, MD, MHS, FCCP, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Suite 4B-73, Baltimore, MD 21224; e-mail: jsevran1@jhmi.edu

Dr. Sevransky had access to all the data in the study, and takes full responsibility for the accuracy of the data analysis and the integrity of the submission.


Presented in part at the Society of Critical Care Medicine International Congress, Hawaii, February 2–6, 2008.

Dr. Sevransky is supported by K-23 GMO7-1399. Dr. Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research. This research is supported by the National Institutes of Health (Acute Lung Injury SCCOR grant P050 HL 73994). The funding bodies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3):534-538. doi:10.1378/chest.08-0309
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Background:  Acute lung injury (ALI) is a frequent complication of sepsis. It is unclear if a pulmonary vs nonpulmonary source of sepsis affects mortality in patients with sepsis-induced ALI.

Methods:  Two hundred eighty-eight consecutive patients with sepsis-induced ALI from 14 ICUs at four hospitals in Baltimore, MD were prospectively classified as having a pulmonary vs nonpulmonary source of sepsis. Multiple logistic regression was conducted to evaluate the independent association of a pulmonary vs nonpulmonary source of sepsis with inpatient mortality.

Results:  In an unadjusted analysis, in-hospital mortality was lower for pulmonary vs nonpulmonary source of sepsis (42% vs 66%, p < 0.0001). Patients with pulmonary sepsis had lower acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores, shorter ICU stays prior to the development of ALI, and higher lung injury scores. In the adjusted analysis, several factors were predictive of mortality: age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.06), Charlson comorbidity index (OR, 1.15; 95% CI, 1.02 to 1.30), ICU length of stay prior to ALI diagnosis (OR, 1.19; 95% CI, 1.01 to 1.39), APACHE II score (OR, 1.07; 95% CI, 1.03 to 1.12), lung injury score (OR, 1.64; 95% CI, 1.11 to 2.43), SOFA score (OR, 1.15; 95% CI, 1.06 to 1.26), and cumulative fluid balance in the first 7 days after ALI diagnosis (OR, 1.06; 95% CI, 1.03 to 1.10). A pulmonary vs nonpulmonary source of sepsis was not independently associated with mortality (OR, 0.72; 95% CI, 0.38 to 1.35).

Conclusions:  Although lower mortality was observed for ALI patients with a pulmonary vs nonpulmonary source of sepsis, this finding is likely due to a lower severity of illness in those with pulmonary sepsis. Pulmonary vs nonpulmonary source of sepsis was not independently predictive of mortality for patients with ALI.

Trial registration:  ClinicalTrials.gov Identifier: NCT00300248.


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