TY  - JOUR
PY  - 2016//
TI  - Risk factors for in-hospital mortality in smoke inhalation-associated acute lung injury: data from 68 United States hospitals
JO  - Chest
A1  - Kadri, Sameer S.
A1  - Miller, Andrew C.
A1  - Hohmann, Samuel
A1  - Bonne, Stephanie L.
A1  - Nielsen, Carrie
A1  - Wells, Carmen
A1  - Gruver, Courtney
A1  - Quraishi, Sadeq A.
A1  - Sun, Junfeng
A1  - Cai, Rongman
A1  - Morris, Peter E.
A1  - Freeman, Bradley D.
A1  - Holmes, James H.
A1  - Cairns, Bruce A.
A1  - Suffredini, Anthony F.
SP  - 1260
EP  - 1268
VL  - 150
IS  - 6
N2  - 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>
LA  - en
SN  - 0012-3692
UR  - http://dx.doi.org/10.1016/j.chest.2016.06.008
ID  - ref1
ER  -