risk factors for the development of acute lung injury in patients with infectious pneumonia发展的危险因素患者急性肺损伤感染肺炎.pdfVIP

Kojicic et al. Critical Care 2012, 16:R46 /content/16/2/R46 RESEARCH Open Access Risk factors for the development of acute lung injury in patients with infectious pneumonia 1,2 1,3 4 1,5 1 1 Marija Kojicic , Guangxi Li , Andrew C Hanson , Kun-Moo Lee , Lokendra Thakur , Jayanth Vedre , 1 6 1 1* Adil Ahmed , Larry M Baddour , Jay H Ryu and Ognjen Gajic Abstract Introduction: Although pneumonia has been identified as the single most common risk factor for acute lung injury (ALI), we have a limited knowledge as to why ALI develops in some patients with pneumonia and not in others. The objective of this study was to determine frequency, risk factors, and outcome of ALI in patients with infectious pneumonia. Methods: A retrospective cohort study of adult patients with microbiologically positive pneumonia, hospitalized at two Mayo Clinic Rochester hospitals between January 1, 2005, and December 31, 2007. In a subsequent nested case-control analysis, we evaluated the differences in prehospital and intrahospital exposures between patients with and without ALI/acute respiratory distress syndrome (ARDS) matched by specific pathogen, isolation site, gender, and closest age in a 1:1 manner. Results: The study included 596 patients; 365 (61.2%) were men. The median age was 65 (IQR, 53 to 75) years. In total, 171 patients (28.7%) were diagnosed with ALI. The occurrence of ALI was less frequent in bacterial (n = 99 of 412, 24%) compared with viral (n = 19 of 55, 35%), fungal (n = 39 of 95, 41%), and mixed isolates pneumonias (n = 14 of 34, 41%; P = 0.002). After adjusting for baseline severity of ill