• Catherine L Auriemma, Hanjing Zhuo, Kevin Delucchi, Thomas Deiss, Tom Liu, Alejandra Jauregui, Serena Ke, Kathryn Vessel, Matthew Lippi, Eric Seeley, Kirsten N Kangelaris, Antonio Gomez, Carolyn Hendrickson, Kathleen D Liu, Michael A Matthay, Lorraine B Ware, and Carolyn S Calfee.
• Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, 839 W. Gates, 3600 Spruce Street, Philadelphia, PA, 19103-4283, USA. Catherine.auriemma@pennmedicine.upenn.edu.
• Intensive Care Med. 2020 Jun 1; 46 (6): 122212311222-1231.

PurposePrevious studies assessing impact of acute respiratory distress syndrome (ARDS) on mortality have shown conflicting results. We sought to assess the independent association of ARDS with in-hospital mortality among intensive care unit (ICU) patients with sepsis.MethodsWe studied two prospective sepsis cohorts drawn from the Early Assessment of Renal and Lung Injury (EARLI; n = 474) and Validating Acute Lung Injury markers for Diagnosis (VALID; n = 337) cohorts. ARDS was defined by Berlin criteria. We used logistic regression to compare in-hospital mortality in patients with and without ARDS, controlling for baseline severity of illness. We also estimated attributable mortality, adjusted for illness severity by stratification.ResultsARDS occurred in 195 EARLI patients (41%) and 99 VALID patients (29%). ARDS was independently associated with risk of hospital death in multivariate analysis, even after controlling for severity of illness, as measured by APACHE II (odds ratio [OR] 1.65 (95% confidence interval [CI] 1.02, 2.67), p = 0.04 in EARLI; OR 2.12 (CI 1.16, 3.92), p = 0.02 in VALID). Patients with severe ARDS (P/F < 100) primarily drove this relationship. The attributable mortality of ARDS was 27% (CI 14%, 37%) in EARLI and 37% (CI 10%, 51%) in VALID. ARDS was independently associated with ICU mortality, hospital length of stay (LOS), ICU LOS, and ventilator-free days.ConclusionsDevelopment of ARDS among ICU patients with sepsis confers increased risk of ICU and in-hospital mortality in addition to other important outcomes. Clinical trials targeting patients with severe ARDS will be best poised to detect measurable differences in these outcomes.

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