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

Sameer S Kadri1, Andrew C Miller2, Samuel Hohmann3

  • 1Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Department of Medicine, Massachusetts General Hospital, Boston, MA.

Chest
|June 19, 2016
PubMed
Summary

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Temporal changes in the protein cargo of extracellular vesicles and resultant immune reprogramming after severe burn injury in humans and mice.

Frontiers in immunology·2025

Mortality in smoke inhalation-associated acute lung injury (SI-ALI) is predicted by older age, major burns, vasopressor use, higher risk-of-mortality scores, and smaller hospital size. Initial antibiotic therapy did not impact survival in SI-ALI patients.

Area of Science:

  • Pulmonary Medicine
  • Critical Care Medicine
  • Burn Surgery

Background:

  • Smoke inhalation-associated acute lung injury (SI-ALI) has substantial mortality.
  • While age and burn surface area are known risk factors, patient and center-level variables impacting survival were previously unknown.

Purpose of the Study:

  • To identify novel predictors of in-hospital mortality in adult patients with SI-ALI.
  • To evaluate the impact of patient demographics, injury severity, and healthcare setting on SI-ALI outcomes.

Main Methods:

  • Retrospective cohort study of 769 adult patients with SI-ALI across 68 US academic medical centers (2011-2014).
  • Inclusion criteria: mechanical ventilation by hospital day 4, with prolonged stay or early death.
  • Logistic regression analysis was used to identify predictors of in-hospital mortality.
Keywords:
adult respiratory distress syndromeburnsepidemiologyrisk factorssmoke inhalation

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Main Results:

  • Overall in-hospital mortality was 26%, rising to 50% for patients with ≥20% surface burns.
  • Independent predictors of mortality included older age (>60 years), ≥20% burns, initial vasopressor use, higher diagnostic-related group (DRG) risk-of-mortality score, and lower hospital bed capacity (<500 beds).
  • Initial empiric antibiotic therapy did not significantly impact survival (OR 0.93, 95% CI 0.58-1.49).

Conclusions:

  • Mortality in SI-ALI is associated with older age, major burns, initial vasopressor administration, higher DRG risk-of-mortality scores, and care at smaller hospitals (<500 beds).
  • Initial antibiotic treatment was not found to be a significant predictor of survival in this cohort.
  • These findings enhance the prediction of SI-ALI mortality by 9.9%.