Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study
Abstract Background Both sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-024-02913-1 |
| _version_ | 1797276020263354368 |
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| author | Dong-Hui Wang Hui-Miao Jia Xi Zheng Xiu-Ming Xi Yue Zheng Wen-Xiong Li |
| author_facet | Dong-Hui Wang Hui-Miao Jia Xi Zheng Xiu-Ming Xi Yue Zheng Wen-Xiong Li |
| author_sort | Dong-Hui Wang |
| collection | DOAJ |
| description | Abstract Background Both sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality of ARDS in critically ill patients with sepsis. Methods The data were obtained from a multicenter, prospective cohort study in 18 Chinese ICUs between January 2014 and August 2015. The study population was septic patients after ICU admission. The patients were categorized into two groups: those who developed ARDS (ARDS group) within seven days following a sepsis diagnosis and those who did not develop ARDS (non-ARDS group). Applying propensity score matching (PSM), patients were matched 1:1 as ARDS and non-ARDS groups. Mortality attributed to ARDS was calculated. Subsequently, we conducted a survival analysis to estimate the impact of ARDS on mortality. The primary endpoint was 30-day mortality after sepsis diagnosis. Results 2323 septic patients were eligible, 67.8% developed ARDS. After PSM, 737 patients with ARDS were matched 1:1 with 737 non-ARDS patients. ARDS’s overall 30-day attributable mortality was 11.9% (95% CI 7.5–16.3%, p < 0.001). Subgroup analysis showed that the 30-day attributable mortality of mild, moderate, and severe ARDS was 10.5% (95% CI 4.0-16.8%, p < 0.001), 11.6% (95% CI 4.7–18.4%, p < 0.001) and 18.1% (95% CI 4.5–30.9%, p = 0.006), respectively. ARDS was an independent risk factor for 30-day mortality, with adjusted hazard ratios of 1.30 (95% CI 1.03–1.64, p = 0.027), 1.49 (95% CI 1.20–1.85, p < 0.001), and 1.95 (95% CI 1.51–2.52, p < 0.001) for mild, moderate, and severe ARDS, respectively. Conclusions The overall 30-day attributable mortality of ARDS among critically ill patients with sepsis was 11.9%. Compared with mild and moderate ARDS, severe ARDS contributed more to death. ARDS was significantly associated with an increase in the 30-day mortality. |
| first_indexed | 2024-03-07T15:22:20Z |
| format | Article |
| id | doaj.art-da180d63a219402cba5db5f43447f134 |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-03-07T15:22:20Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-da180d63a219402cba5db5f43447f1342024-03-05T17:34:44ZengBMCBMC Pulmonary Medicine1471-24662024-03-0124111110.1186/s12890-024-02913-1Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort studyDong-Hui Wang0Hui-Miao Jia1Xi Zheng2Xiu-Ming Xi3Yue Zheng4Wen-Xiong Li5Department of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Critical Care Medicine, Fuxing Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityDepartment of Surgical Intensive Care Unit, Beijing Chao-yang Hospital, Capital Medical UniversityAbstract Background Both sepsis and acute respiratory distress syndrome (ARDS) are common severe diseases in the intensive care unit (ICU). There is no large-scale multicenter study to clarify the attributable mortality of ARDS among septic patients. This study aimed to evaluate the excess mortality of ARDS in critically ill patients with sepsis. Methods The data were obtained from a multicenter, prospective cohort study in 18 Chinese ICUs between January 2014 and August 2015. The study population was septic patients after ICU admission. The patients were categorized into two groups: those who developed ARDS (ARDS group) within seven days following a sepsis diagnosis and those who did not develop ARDS (non-ARDS group). Applying propensity score matching (PSM), patients were matched 1:1 as ARDS and non-ARDS groups. Mortality attributed to ARDS was calculated. Subsequently, we conducted a survival analysis to estimate the impact of ARDS on mortality. The primary endpoint was 30-day mortality after sepsis diagnosis. Results 2323 septic patients were eligible, 67.8% developed ARDS. After PSM, 737 patients with ARDS were matched 1:1 with 737 non-ARDS patients. ARDS’s overall 30-day attributable mortality was 11.9% (95% CI 7.5–16.3%, p < 0.001). Subgroup analysis showed that the 30-day attributable mortality of mild, moderate, and severe ARDS was 10.5% (95% CI 4.0-16.8%, p < 0.001), 11.6% (95% CI 4.7–18.4%, p < 0.001) and 18.1% (95% CI 4.5–30.9%, p = 0.006), respectively. ARDS was an independent risk factor for 30-day mortality, with adjusted hazard ratios of 1.30 (95% CI 1.03–1.64, p = 0.027), 1.49 (95% CI 1.20–1.85, p < 0.001), and 1.95 (95% CI 1.51–2.52, p < 0.001) for mild, moderate, and severe ARDS, respectively. Conclusions The overall 30-day attributable mortality of ARDS among critically ill patients with sepsis was 11.9%. Compared with mild and moderate ARDS, severe ARDS contributed more to death. ARDS was significantly associated with an increase in the 30-day mortality.https://doi.org/10.1186/s12890-024-02913-1SepsisAcute respiratory distress syndromeAttributable mortalityPropensity score matching |
| spellingShingle | Dong-Hui Wang Hui-Miao Jia Xi Zheng Xiu-Ming Xi Yue Zheng Wen-Xiong Li Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study BMC Pulmonary Medicine Sepsis Acute respiratory distress syndrome Attributable mortality Propensity score matching |
| title | Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_full | Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_fullStr | Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_full_unstemmed | Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_short | Attributable mortality of ARDS among critically ill patients with sepsis: a multicenter, retrospective cohort study |
| title_sort | attributable mortality of ards among critically ill patients with sepsis a multicenter retrospective cohort study |
| topic | Sepsis Acute respiratory distress syndrome Attributable mortality Propensity score matching |
| url | https://doi.org/10.1186/s12890-024-02913-1 |
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