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The Impact of Smoking on Morbidity and Mortality in Adults With Severe Sepsis and Septic Shock FREE TO VIEW

Fahad Alroumi, MD; Jasmit Minhas, MD; Ahmed Abdul Azim, MD; Yuxiu Lei, PhD; James Dargin, MD
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Lahey Hospital and Medical Center, Burlington, MA

Chest. 2015;148(4_MeetingAbstracts):352A. doi:10.1378/chest.2248730
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To determine the impact of smoking on morbidity and mortality in patients with severe sepsis and septic shock.

METHODS: We performed a retrospective analysis of immunocompetent, adult patients with severe sepsis and septic shock at a tertiary center. We recorded data from the medical record including smoking status, demographics, body mass index, co-morbidities, APACHE II, and SOFA scores. The primary outcome was hospital mortality. Secondary outcomes included Intensive care unit (ICU) and hospital length of stay (LOS) and need for mechanical ventilation, vasopressors, or renal replacement therapy (RRT). Outcomes were stratified by current, former, or never smokers. Chi-square test and logistic regression were used to assess the categorical outcomes. Kruskall-Wallis test was used to test the difference amongst continuous outcomes with the varied smoking histories. Multivariate linear regression was used to evaluate the association of the continuous outcomes with multiple risk factors.

RESULTS: We included 158 patients with severe sepsis or septic shock. Median age was 72 years (IQR 60, 84), 61% were male, 19% (30/158) were current smokers, 43% (68/158) former, and 38% (60/158) never smoked. The mean SOFA score was 6.5 +/- 4.24 and the mean Charlson co-morbidity index was 4.89 +/-2.65. Pneumonia was the most common source of infection (40%, 63/158) and 46% (73/158) developed septic shock. The overall inpatient mortality was 20% (31/158). The median hospital and ICU LOS were 8 (IQR 4, 14) and 5 days (IQR 3, 11), respectively. Active smoking was not predictive of inpatient mortality (OR 1.99, 95%CI 0.6-6.8, p=0.25). Active smoking predicted the need mechanical ventilation (OR 3.0, 95%CI 1.2-7.4, p<0.01), but not the need for vasopressors (p=0.66), vasopressor days (0.49), need for RRT (p=0.15), RRT days (p=0.39), ICU LOS (p=0.52), or hospital LOS (p=0.11).

CONCLUSIONS: Active smoking is associated with the need for mechanical ventilation, but not with inpatient mortality or other markers of morbidity in patients with severe sepsis or septic shock.

CLINICAL IMPLICATIONS: Smoking cessation may help to reduce the need for mechanical ventilation in patients who develop severe sepsis or septic shock.

DISCLOSURE: The following authors have nothing to disclose: Fahad Alroumi, Jasmit Minhas, Ahmed Abdul Azim, Yuxiu Lei, James Dargin

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