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Original Research: Critical Care |

Drug-Associated Acute Lung InjuryDrug-Associated Acute Lung Injury: A Population-Based Cohort Study

Rajanigandha Dhokarh, MD; Guangxi Li, MD; Christopher N. Schmickl, MD; Rahul Kashyap, MD; Jyoti Assudani, MD; Andrew H. Limper, MD, FCCP; Ognjen Gajic, MD, FCCP
Author and Funding Information

From the Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group (Drs Dhokarh, Li, Schmickl, Kashyap, Assudani, and Gajic), Division of Pulmonary and Critical Care Medicine (Dr Limper), Mayo Clinic, Rochester, MN; the Department of Pulmonary and Critical Care Medicine (Dr Dhokarh), Lahey Clinic, Burlington, MA; the Department of Pulmonary Medicine (Dr Li), Guang’anmen Hospital, China Academy of Chinese Medical Science, Beijing, China; and the University Witten-Herdecke (Dr Schmickl), Witten, Germany.

Correspondence to: Rajanigandha Dhokarh, MD, One Leighton St, 2101, Cambridge, MA 02141; e-mail: rdhokarh@gmail.com


Funding/Support: This work was supported in part by the National Institutes of Health [LM10468Z-01] and by the Mayo Clinic, Rochester, MN.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):845-850. doi:10.1378/chest.11-2103
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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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