Rajanigandha Dhokarh1, Guangxi Li2, Christopher N Schmickl3, Rahul Kashyap4, Jyoti Assudani4, Andrew H Limper5, Ognjen Gajic4. 1. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group, Rochester, MN; Department of Pulmonary and Critical Care Medicine, Lahey Clinic, Burlington, MA. Electronic address: rdhokarh@gmail.com. 2. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group, Rochester, MN; Department of Pulmonary Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Science, Beijing, China. 3. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group, Rochester, MN; University Witten-Herdecke, Witten, Germany. 4. Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) group, Rochester, MN. 5. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Abstract
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 5 .03), ICU mortality (35% vs 20%, P 5 .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 5 .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.
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 illpatients 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 5 .03), ICU mortality (35% vs 20%, P 5 .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 5 .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.
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R LeGall; A Morris; R Spragg Journal: J Crit Care Date: 1994-03 Impact factor: 3.425
Authors: Aude Gibelin; Antoine Parrot; Bernard Maitre; Christian Brun-Buisson; Armand Mekontso Dessap; Muriel Fartoukh; Nicolas de Prost Journal: Intensive Care Med Date: 2015-09-25 Impact factor: 17.440