@article{ref1,
title="Risk factors for in-hospital mortality in smoke inhalation-associated acute lung injury: data from 68 United States hospitals",
journal="Chest",
year="2016",
author="Kadri, Sameer S. and Miller, Andrew C. and Hohmann, Samuel and Bonne, Stephanie L. and Nielsen, Carrie and Wells, Carmen and Gruver, Courtney and Quraishi, Sadeq A. and Sun, Junfeng and Cai, Rongman and Morris, Peter E. and Freeman, Bradley D. and Holmes, James H. and Cairns, Bruce A. and Suffredini, Anthony F.",
volume="150",
number="6",
pages="1260-1268",
abstract="BACKGROUND: Mortality after smoke inhalation-associated acute lung injury (SI-ALI) remains substantial. Age and burn surface area are risk factors of mortality, while the impact of patient and center-level variables and treatments on survival are unknown. <br><br>METHODS: We performed a retrospective cohort study of burn and non-burn centers at 68 United States academic medical centers from 2011-2014. Adult SI-ALI inpatients were identified using an algorithm based on a billing code for respiratory conditions from smoke inhalation who were mechanically ventilated by hospital day 4, with either a length-of-stay ≥ 5-days or death within 4 days of hospitalization. Predictors of in-hospital mortality were identified using logistic regression. The primary outcome was the odds ratio for in-hospital mortality. <br><br>RESULTS: 769 patients (52.9 ± 18.1 years) with SI-ALI were analyzed. In-hospital mortality was 26% in the SI-ALI cohort and 50% in patients with ≥20% surface burns. In addition to age > 60 years (OR 5.1, 95%CI 2.53-10.26) and ≥20% burns (OR 8.7, 95%CI 4.55-16.75), additional risk factors of in-hospital mortality included initial vasopressor use (OR 5.0, 95%CI 3.16-7.91), higher DRG-based risk-of-mortality assignment and lower hospital bed capacity (OR 2.3, 95%CI 1.23-4.15). Initial empiric antibiotics (OR 0.93, 95%CI 0.58-1.49) did not impact survival. These new risk factors improved mortality prediction (ΔAUC) by 9.9%(p<0.001). <br><br>CONCLUSIONS: In addition to older age and major surface burns, mortality in SI-ALI is predicted by initial vasopressor use, higher DRG-based risk-of-mortality assignment and care at centers with <500 beds, but not by initial antibiotic therapy.<br><br>Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0012-3692",
doi="10.1016/j.chest.2016.06.008",
url="http://dx.doi.org/10.1016/j.chest.2016.06.008"
}