Risk Factors for In-Hospital Mortality in Smoke Inhalation-Associated Acute Lung Injury: Data From 68 United States Hospitals

Sameer S. Kadri, Andrew C. Miller, Samuel Hohmann, Stephanie Bonne, Carrie Nielsen, Carmen Wells, Courtney Gruver, Sadeq A. Quraishi, Junfeng Sun, Rongman Cai, Peter E. Morris, Bradley D. Freeman, James H. Holmes, Bruce A. Cairns, Anthony F. Suffredini

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Background Mortality after smoke inhalation–associated acute lung injury (SI-ALI) remains substantial. Age and burn surface area are risk factors of mortality, whereas the impact of patient- and center-level variables and treatments on survival are unknown. Methods We performed a retrospective cohort study of burn and non-burn centers at 68 US academic medical centers between 2011 and 2014. Adult inpatients with SI-ALI 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. Results A total of 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 diagnostic-related group–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 by 9.9% (P < .001). Conclusions In addition to older age and major surface burns, mortality in SI-ALI is predicted by initial vasopressor use, higher diagnostic-related group–based risk-of-mortality assignment, and care at centers with < 500 beds, but not by initial antibiotic therapy.

Original languageEnglish
Pages (from-to)1260-1268
Number of pages9
JournalChest
Volume150
Issue number6
DOIs
StatePublished - Dec 1 2016

Bibliographical note

Publisher Copyright:
© 2016

Keywords

  • adult respiratory distress syndrome
  • burns
  • epidemiology
  • risk factors
  • smoke inhalation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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