Post-operative sepsis-induced acute respiratory distress syndrome: risk factors for a life-threatening complication

Miguel Bardají-Carrillo; Marta Martín-Fernández; Rocío López-Herrero; Juan Manuel Priede-Vimbela; María Heredia-Rodríguez; Esther Gómez-Sánchez; Estefanía Gómez-Pesquera; Mario Lorenzo-López; Pablo Jorge-Monjas; Rodrigo Poves-Álvarez; Jesús Villar; Eduardo Tamayo

doi:10.3389/fmed.2024.1338542

Post-operative sepsis-induced acute respiratory distress syndrome: risk factors for a life-threatening complication

Front Med (Lausanne). 2024 Mar 5:11:1338542. doi: 10.3389/fmed.2024.1338542. eCollection 2024.

Authors

Miguel Bardají-Carrillo^{1

2

3}, Marta Martín-Fernández^{1

3

4}, Rocío López-Herrero^{1

2

3

5}, Juan Manuel Priede-Vimbela^{1

2

3}, María Heredia-Rodríguez^{1

3

6}, Esther Gómez-Sánchez^{1

2

3

5}, Estefanía Gómez-Pesquera^{1

2

3

5}, Mario Lorenzo-López^{1

2

3

5}, Pablo Jorge-Monjas^{1

2

3

5}, Rodrigo Poves-Álvarez^{1

2

3

5}, Jesús Villar^{7

8

9}, Eduardo Tamayo^{1

2

3

5}

Affiliations

¹ BioCritic, Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain.
² Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain.
³ Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
⁴ Department of Medicine, Toxicology and Dermatology, University of Valladolid, Valladolid, Spain.
⁵ Department of Surgery, University of Valladolid, Valladolid, Spain.
⁶ Department of Anaesthesiology and Critical Care, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
⁷ CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
⁸ Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.
⁹ Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, ON, Canada.

Abstract

Introduction: Prevalence and mortality of the acute respiratory distress syndrome (ARDS) in intensive care units (ICU) are unacceptably high. There is scarce literature on post-operative sepsis-induced ARDS despite that sepsis and major surgery are conditions associated with ARDS. We aimed to examine the impact of post-operative sepsis-induced ARDS on 60-day mortality.

Methods: We performed a secondary analysis of a prospective observational study in 454 patients who underwent major surgery admitted into a single ICU. Patients were stratified in two groups depending on whether they met criteria for ARDS. Primary outcome was 60-day mortality of post-operative sepsis-induced ARDS. Secondary outcome measures were potential risk factors for post-operative sepsis-induced ARDS, and for 60-day mortality.

Results: Higher SOFA score (OR 1.1, 95% CI 1.0-1.3, p = 0.020) and higher lactate (OR 1.9, 95% CI 1.2-2.7, p = 0.004) at study inclusion were independently associated with ARDS. ARDS patients (n = 45) had higher ICU stay [14 (18) vs. 5 (11) days, p < 0.001] and longer need for mechanical ventilation [6 (14) vs. 1 (5) days, p < 0.001] than non-ARDS patients (n = 409). Sixty-day mortality was higher in ARDS patients (OR 2.7, 95% CI 1.1-6.3, p = 0.024). Chronic renal failure (OR 4.0, 95% CI 1.2-13.7, p = 0.026), elevated lactate dehydrogenase (OR 1.7, 95% CI 1.1-2.7, p = 0.015) and higher APACHE II score (OR 2.7, 95% CI 1.3-5.4, p = 0.006) were independently associated with 60-day mortality.

Conclusion: Post-operative sepsis-induced ARDS is associated with higher 60-day mortality compared to non-ARDS post-operative septic patients. Post-operative septic patients with higher severity of illness have a greater risk of ARDS and worse outcomes. Further investigation is needed in post-operative sepsis-induced ARDS to prevent ARDS.

Keywords: ARDS; post-operative sepsis-induced ARDS; sepsis; septic shock; surgical patients.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by Instituto de Salud Carlos III (PI21/00917, PI18/01238, and CIBERINFEC CB21/13/00051), Junta de Castilla y León (GRS 2546/A/22, GRS 2425/A/ 21, GRS 1922/A/19, and GRS 2057/A/19), Consejería de Educación de Castilla y León (VA256P20) and Fundación Ramón Areces (CIVP19A5953). JV was supported by Instituto de Salud Carlos III (CB06/06/1088, PI 19/00141, and AC21-2/00039-ERAPerMed).