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KARAKTERISTIK KLINIS DAN LUARAN

ARDS DENGAN SEPSIS DAN ARDS


TANPA SEPSIS
Sheu CC,Gong MN,Zhai R,Chen F,Bajwa EK,Clardy
PF,et al. Clinical Characteristics and Outcomes of SepsisRelated vs Non-Sepsis-Related ARDS. Chest. 2010 Sep;
138(3): 559567.

Dipresentasikan Oleh
DAVID YOSUA KABAN

LATAR BELAKANG
PERBEDAA
N
KEDUANYA
BELUM
BANYAK
DIKETAHUI

METODE PENELITIAN
Bakteremia, sepsis,
pneumonia, trauma,
aspirasi, transfusi
berulang

Inklusi

<
Eksklus
i

18 Tahun
Perdarahan difus alveolar
Penyakit paru kronik
selain COPD dan Asma
Immunosupressi selain
kortikosteroid
Terapi granulocyte
colony-stimulating factor

METODE PENELITIAN

HASIL
Table 1
Baseline Characteristics of Study Population

Data are presented as median (25th-75th percentile) or No. (%). APACHE = Acute Physiology
and Chronic Health Evaluation; BIDMC = Beth Israel Deaconess Medical Center; MGH =
Massachusetts General Hospital.

Characteristic
Age, y
Male sex
White
APACHE III score
BMI, kg/m2
Hospitals
MGH
BIDMC
ICU
Medical
Surgical
Coronary care unit
Neurologic
Others
Predisposing conditions
Sepsis related
Sepsis without shock
Septic shock
Bacteremia
Pneumonia
Non-sepsis related
Trauma
Multiple transfusions
Aspiration
Postoperation
Diabetes
End-stage renal disease
Liver cirrhosis
Metastatic cancers
History of alcohol abuse

ARDS (n = 586)
60 (45-73)
356 (60.8)
530 (90.4)
77 (61-92)
26.9 (23.3-31.6)
509 (86.9)
77 (13.1)
297 (50.8)
170 (29.1)
88 (15.0)
18 (3.1)
12 (2.0)
524 (89.4)
151 (28.8)
373 (71.2)
109 (20.8)
408 (77.9)
62 (10.6)
27 (43.5)
35 (56.5)
8 (12.9)
26 (4.4)
118 (20.5)
46 (8.0)
46 (8.0)
13 (2.3)
90 (15.4)

HASI
L
Table 2
Characteristics Between
ARDS Survivors and
Nonsurvivors

Data are presented as median (25th-75th


percentile) or No. (%), unless otherwise
indicated. H2O = water; PEEP = positive
end-expiratory pressure. See Table 1
legend for expansion of other
abbreviations.

Characteristic

Survivors (n = 372)

Nonsurvivors (n =
214)

PValue

54 (39-67)
230 (61.8)
333 (89.5)
70 (54-85)
27.5 (23.7-33.0)

68 (57-78)
126 (58.9)
197 (92.1)
88 (74-105)
25.8 (22.7-29.6)

< .0001
.481
.314
< .0001
.002

64 (17.2)
324 (87.1)
250 (67.2)
26 (7.0)
23 (6.2)
7 (1.9)

45 (21.0)
200 (93.5)
158 (73.8)
1 (0.5)
12 (5.6)
1 (0.5)

.252
.017
.093
.0001
.778
.269

16 (4.3)
70 (19.2)
26 (7.1)
16 (4.4)
5 (1.4)
56 (15.1)
142 (38.2)

10 (4.7)
48 (22.5)
20 (9.4)
30 (14.1)
8 (3.8)
34 (15.9)
108 (50.5)

.833
.342
.336
< .0001
.081
.787
.004

16.2 (11.6-21.6)
29.5 (26.6-33.6)
189 (116-282)
172 (141-230)
0.8 (0.5-1.5)
1.2 (0.9-2.1)
2.3 (1.8-2.7)

16.6 (11.5-24.1)
29.4 (25.9-33.0)
161 (79-253)
192 (149-258)
1.1 (0.6-3.3)
1.6 (0.9-2.8)
2.2 (1.7-2.7)

.254
.505
.002
.009
.0002
.0007
.767
.010

158 (42.5)
214 (57.5)

76 (35.5)
138 (64.5)

2.7 (2.0-3.0)
7.34 (7.26-7.40)
131 (84-195)

2.3 (2.0-3.0)
7.33 (7.26-7.43)
122 (84-210)

.947
.342
.858

PaCO2, mm Hg

42 (37-49)

42 (34-50)

.359

PEEP, cm H2O

8.5 (5-10)

8 (5-10)

.204

500 (420-600)

500 (400-600)

.518

250 (67.2)
235 (63.7)

157 (73.4)
165 (77.1)

.119
.0005

Age, y
Male sex
White
APACHE III score
BMI, kg/m2
Predisposing conditions
Bacteremia
Sepsis
Pneumonia
Trauma
Multiple transfusions
Aspiration
Comorbidities
Postoperation
Diabetes
End-stage renal disease
Liver cirrhosis
Metastatic cancers
History of alcohol abuse
Pre-ICU hospital stay 48 h
Laboratory values on ICU
admission
WBC count, 103/mm3
Hematocrit, %
Platelet count, 103/mm3
Serum glucose, mg/dL
Serum bilirubin, mg/dL
Serum creatinine, mg/dL
Serum albumin, g/dL
ARDS diagnosis
Upon ICU admission
After ICU admission
On diagnosis of ARDS
Lung injury score
pH
PaO2/FIO2ratio

Tidal volume, mL
Vasopressors used
< 24 h after ICU admission
< 24 h after ARDS diagnosis

HASIL

Characteristics
Age, y
Male sex
APACHE III score
BMI, kg/m2
Predisposing conditions
Bacteremia
Septic shock
Pneumonia
Trauma
Multiple transfusions
Aspiration
Comorbidities
Postoperation
Diabetes
End-stage renal disease
Liver cirrhosis
Metastatic cancers
History of alcohol abuse
Pre-ICU hospital stay 48 h
Laboratory values on ICU admission
WBC count, 103/mm3
Hematocrit, %
Platelet count, 103/mm3
Serum glucose, mg/dL
Serum bilirubin, mg/dL
Serum creatinine, mg/dL
Serum albumin, g/dL
ARDS development
On ICU admission
After ICU admission
On diagnosis of ARDS
Lung injury score
pH
PaO2/FIO2ratio
PaCO2, mm Hg

Table 3
Clinical Characteristics
Between Patients With
Sepsis-Related and
Non-Sepsis-Related ARDS

Data are presented as median (25th75th percentile) or No. (%), unless


otherwise indicated. See Table 1 and
and22 legends for expansion of
abbreviations.

PEEP, cm H2O
Vasopressors
On ICU admission
On ARDS diagnosis
Serial PaO2/FIO2ratio after ARDS
ARDS day 1
ARDS day 3
ARDS day 7

Sepsis-Related ARDS (n = 524)


60 (45-73)
309 (59.0)
78 (62-94)
27.0 (23.2-31.8)

Non-Sepsis-Related ARDS (n = 62)


58 (37-75)
47 (75.8)
65 (46-78)
26.2 (24.0-30.6)

109 (20.8)
373 (71.2)
408 (77.9)
0
0
0

0
0
0
27 (43.5)
35 (56.5)
8 (12.9)

<
<
<
<
<
<

9 (1.7)
114 (22.0)
45 (8.7)
44 (8.5)
12 (2.3)
85 (16.2)
244 (46.6)

17
4
1
2
1
5
6

< .0001
.006
.073
.211
.761
.092
< .0001

(27.4)
(6.8)
(1.7)
(3.4)
(1.7)
(8.1)
(9.7)

PValue
.403
.010
< .0001
.634
.0001
.0001
.0001
.0001
.0001
.0001

16.8 (12.1-23.5)
29.7 (26.6-33.7)
189 (114-279)
177 (140-245)
0.9 (0.5-1.9)
1.3 (0.9-2.5)
2.2 (1.8-2.7)

13.3 (9.7-16.8)
27.9 (25.0-31.2)
97 (57-154)
182 (162-288)
0.7 (0.5-1.2)
1.2 (0.9-1.7)
2.4 (2.0-2.8)

.0003
.006
< .0001
.351
.081
.087
.027
.087

203 (38.7)
321 (61.3)

31 (50)
31 (50)

2.3 (2.0-3.0)
7.34 (7.26-7.41)
127 (84-191)
41 (35-49)

2.7 (2.0-3.0)
7.32 (7.25-7.37)
140 (88-256)
43.5 (38-52)

.592
.131
.120
.182

8 (5-10)

9.3 (5-10)

.912

370 (70.6)
372 (71.0)

37 (59.7)
28 (45.2)

.077
< .001

127 (84-191)
143 (87-216)
145 (100-207)

140 (88-256)
181 (103-264)
168 (135-260)

.120
.018
.004

HASIL
Table 4
Clinical Outcomes Between Patients With Sepsis-Related and Non-Sepsis-Related ARDS
Clinical
Outcome

Sepsis-Related
ARDS (n = 524)

Non-SepsisRelated ARDS (n
= 62)

PValue

28-d mortality

163 (31.1)

10 (16.3)

.015

60-d mortality

200 (38.2)

14 (22.6)

.016

16 (9-28)

12 (8-18)

.010

ICU-free days in
28 d

1 (0-16)

14 (0-20)

.0001

Ventilator-free
days in 28 d

3 (0-18)

13 (0-21)

.003

Total ventilator
days, survivors

14 (8-26)

12 (6-20)

.097

ICU LOS,
survivors, d

Successful
281 (53.6)
45 (72.6)
extubation
in 28
d (25th-75th percentile) or No. (%), unless otherwise indicated. LOS
Data are presented
as median
= length of stay.

.005

HASIL
Figure 2.

Kaplan-Meier curves for 60-day survival between patients with


sepsis-related ARDS and patients with non-sepsis-related
ARDS.Pvalue was obtained by log-rank test.

HASIL
Table 5
Multivariate Analysis for Predictors of ARDS Mortality
Predictor
Sepsis-related vs nonsepsis-related ARDS

HR (95% CI)a
1.26 (0.71-2.22)

PValueb
.434

Age, y

1.03 (1.02-1.04)

< .0001

APACHE III score

1.02 (1.01-1.02)

< .0001

Liver cirrhosis

1.85 (1.09-3.15)

.023

Metastatic cancers

2.89 (1.32-6.37)

.008

Serum bilirubin, mg/dL

1.04 (1.02-1.06)

.0007

Serum glucose, 10
mg/dL

1.02 (1.00-1.03)

.029

Treatment with
0.47 (0.23-0.99)
HR = hazard ratio. See Table 1 legend for expansion of other abbreviation.
activated
C in a multivariate Cox proportional hazard model, with stratification by calendar year.
The HR protein
and 95% CI were calculated

.046

Candidate variables with P < .20 in Table 2 were entered into the model. The variable representing sepsis-related vs non-sepsis-related ARDS was forced
to be retained in the final model, whereas the covariates were selected using backward selection algorithm with criteria of P > .05 for eliminating variables.
b

KESIMPULAN

KESIMPULAN