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Original Research: Critical Care |

Sex, Race, and the Development of Acute Lung InjurySex, Race, and Development of Acute Lung Injury

Luciano B. Lemos-Filho, MD; Mark E. Mikkelsen, MD; Greg S. Martin, MD, FCCP; Ousama Dabbagh, MD, FCCP; Adebola Adesanya, MD, FCCP; Nina Gentile, MD; Annette Esper, MD; Ognjen Gajic, MD, FCCP; Michelle N. Gong, MD; for the US Critical Illness and Injury Trials Group: Lung Injury Prevention Study Investigators (USCIITG-LIPS)*
Author and Funding Information

From Montefiore Medical Center/Albert Einstein College of Medicine (Drs Lemos-Filho and Gong), Bronx, NY; Perelman School of Medicine at the University of Pennsylvania (Dr Mikkelsen), Philadelphia, PA; Emory University (Drs Martin and Esper), Atlanta, GA; University of Missouri (Dr Dabbagh), Columbia, MO; University of Texas Southwestern Medical Center (Dr Adesanya), Dallas, TX; Temple University School of Medicine (Dr Gentile), Philadelphia, PA; and Mayo Clinic (Dr Gajic), Rochester, MN.

Correspondence to: Michelle N. Gong, MD, 111 E 210th St, Critical Care Medicine-Gold Zone, Bronx, NY 10467; e-mail: mgong@montefiore.org


*

A complete list of study participants is located in e-Appendix 1.

Funding/Support: This study was supported by the United States Critical Illness and Injury Trials Group (USCIITG) [NIGMS U01 GM083407, NHLBI HL60710, HL086667, NHLBI 108712 and HL084060].

For editorial comment see page 881

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


Chest. 2013;143(4):901-909. doi:10.1378/chest.12-1118
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Background:  Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations.

Methods:  This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates.

Results:  The incidence of ALI development was 5.9%; in-hospital mortality was 5.0% for the entire cohort, and 24.4% for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9% vs 4.7%, P < .001) and had a nonsignificant increase in mortality when ALI developed (27.6% vs 18.5%, P = .08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5% vs. 6.5%, P = .014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 % CI, 0.45-0.96).

Conclusions:  Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.

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