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Original Research: Critical Care |

Risk Factors for In-Hospital Mortality in Smoke Inhalation-Associated Acute Lung Injury: Data From 68 United States Hospitals

Sameer S. Kadri, MD; Andrew C. Miller, MD; Samuel Hohmann, PhD; Stephanie Bonne, MD; Carrie Nielsen, MA; Carmen Wells, RN; Courtney Gruver, RN; Sadeq A. Quraishi, MD; Junfeng Sun, PhD; Rongman Cai, PhD; Peter E. Morris, MD; Bradley D. Freeman, MD; James H. Holmes, MD; Bruce A. Cairns, MD; Anthony F. Suffredini, MD
Author and Funding Information

Drs Cairns and Suffredini contributed equally to this manuscript.

FUNDING/SUPPORT: This study was funded by the Intramural Research Program, National Institutes of Health.

aCritical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD

bDepartment of Medicine, Massachusetts General Hospital, Boston, MA

cDepartment of Emergency Medicine, West Virginia University, Morgantown, WV

dUniversity HealthSystem Consortium, Chicago, IL

eDepartment of Health Systems Management, Rush University, Chicago, IL

fDepartment of Surgery, Washington University School of Medicine, St. Louis, MO

gNorth Carolina Jaycee Burn Center, University of North Carolina Hospital, Chapel Hill, NC

hDepartment of General Surgery, Wake Forest Medical Center, Wake Forest School of Medicine, Winston-Salem, NC

iDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

jDepartment of Anesthesia, Harvard Medical School, Boston, MA

kDivision of Pulmonary and Critical Care Medicine, Wake Forest Medical Center, Wake Forest School of Medicine, Winston-Salem, NC

CORRESPONDENCE TO: Sameer S. Kadri, MD, Critical Care Medicine Department, National Institutes of Health Clinical Center, 10 Center Dr, Room 2C145, Bethesda, MD 20892-1662


Copyright 2016, . All Rights Reserved.


Chest. 2016;150(6):1260-1268. doi:10.1016/j.chest.2016.06.008
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Background  Mortality after smoke inhalation–associated acute lung injury (SI-ALI) remains substantial. Age and burn surface area are risk factors of mortality, whereas the impact of patient- and center-level variables and treatments on survival are unknown.

Methods  We performed a retrospective cohort study of burn and non-burn centers at 68 US academic medical centers between 2011 and 2014. Adult inpatients with SI-ALI were identified using an algorithm based on a billing code for respiratory conditions from smoke inhalation who were mechanically ventilated by hospital day 4, with either a length-of-stay ≥ 5 days or death within 4 days of hospitalization. Predictors of in-hospital mortality were identified using logistic regression. The primary outcome was the odds ratio for in-hospital mortality.

Results  A total of 769 patients (52.9 ± 18.1 years) with SI-ALI were analyzed. In-hospital mortality was 26% in the SI-ALI cohort and 50% in patients with ≥ 20% surface burns. In addition to age > 60 years (OR 5.1, 95% CI 2.53-10.26) and ≥ 20% burns (OR 8.7, 95% CI 4.55-16.75), additional risk factors of in-hospital mortality included initial vasopressor use (OR 5.0, 95% CI 3.16-7.91), higher diagnostic-related group–based risk-of-mortality assignment and lower hospital bed capacity (OR 2.3, 95% CI 1.23-4.15). Initial empiric antibiotics (OR 0.93, 95% CI 0.58-1.49) did not impact survival. These new risk factors improved mortality prediction by 9.9% (P < .001).

Conclusions  In addition to older age and major surface burns, mortality in SI-ALI is predicted by initial vasopressor use, higher diagnostic-related group–based risk-of-mortality assignment, and care at centers with < 500 beds, but not by initial antibiotic therapy.

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