Citation

Dhokarh R, Li G, Schmickl CN, Kashyap R, Assudani J, Limper AH, Gajic O. Chest 2012; 142(4): 845-850.

Affiliation

1(M.E.T.R.I.C.) Multidisciplinary Epidemiology and Translational Research in Intensive Care, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.

Copyright

(Copyright © 2012, American College of Chest Physicians)

DOI

10.1378/chest.11-2103

PMID

22539646

Abstract

BACKGROUND:A number of drugs have been reported as risk factors for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). However, evidence is largely limited to case reports and there is paucity of data on the incidence and outcome of drug associated acute lung injury (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 or not they were exposed to pre-specified 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% confidence interval, 95%-CI=4.8 to 8.5) per 100,000 person-years. Of the 49 patients with DALI, 36 had received chemotherapeutic/anti-inflammatory agents and 14 had received amiodarone. Twelve patients had no additional risk factors for ALI (probable DALI) while 37 had alternative risk factors (possible DALI). Patients with and without DALI had similar baseline characteristics. However, the APACHE III scores (median 83 vs. 70, p=0.03), ICU mortality (35% vs. 20%, p=0.03) and hospital mortality (63% vs. 32%, p<0.001) 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 (odds ratio 2.8, 95%-confidence interval, 1.3 to 6.4, p=0.009). 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.

Language: en