Intensive Care Medicine

, Volume 36, Issue 6, pp 963–970 | Cite as

The influence of infection sites on development and mortality of ARDS

  • Chau-Chyun Sheu
  • Michelle N. Gong
  • Rihong Zhai
  • Ednan K. Bajwa
  • Feng Chen
  • B. Taylor Thompson
  • David C. ChristianiEmail author



Infection is the most frequent cause of acute respiratory distress syndrome (ARDS). However, little is known about the influence of infection sites on ARDS. This study aimed to assess the associations of infection sites with ARDS development and mortality in critically ill infected patients.


Prospective observational study.


Adult intensive care units (ICUs) of an academic medical center.


Study population included 1,973 consecutive patients admitted to ICUs with bacteremia, pneumonia or sepsis. During follow-up, 549 patients developed ARDS and 212 of them died within 60 days.

Main results

The distribution of infection sites in ARDS patients was: lung (77.2%), abdomen (19.3%), skin/soft tissues (6.0%), urinary tract (4.7%), unknown (2.6%), and multiple sites (17.7%). On multivariate analysis, lung was the only infection site associated with increased ARDS risk [adjusted odds ratio (OR) 3.49]. Urinary tract (adjusted OR 0.43), skin/soft tissue (adjusted OR 0.64), and unknown-site infections (adjusted OR 0.38) were associated with decreased risk. No association was found between individual infection site and ARDS mortality. However, unknown-site [adjusted hazard ratio (HR) 3.08] and multiple-site infections (adjusted HR 1.63) were associated with increased ARDS mortality. When grouping patients into pulmonary, nonpulmonary, and combined infections, nonpulmonary infection was associated with decreased ARDS risk (adjusted OR 0.28) and combined infections was associated with increased ARDS mortality (adjusted HR 1.69), compared with pulmonary infection.


In critically ill infected patients, pulmonary infection is associated with higher risk of ARDS development than are infections at other sites. Pulmonary versus nonpulmonary infection significantly affects ARDS development but not mortality.


Acute respiratory distress syndrome Epidemiology Infection Pneumonia Mortality Risk factors 



This study was supported by grants ES00002, HL60710, and HL087934 from National Institutes of Health, USA. The authors would like to thank Thomas McCabe, Julia Shin, Hanae Fujii-Rios, Ian Taggart, and Kezia Ellison for patient recruitment; Andrea Shafer and Starr Sumpter for research support; Janna Frelich, Marcia Chertok, and Julie DelPrato for data management; and the patients and staff of ICUs at Massachusetts General Hospital.

Conflict of interest statement

The authors have not disclosed any potential conflicts of interest.

Supplementary material

134_2010_1851_MOESM1_ESM.doc (108 kb)
Supplementary material (DOC 107 kb)


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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Chau-Chyun Sheu
    • 1
    • 5
    • 6
  • Michelle N. Gong
    • 3
    • 4
  • Rihong Zhai
    • 1
  • Ednan K. Bajwa
    • 2
  • Feng Chen
    • 1
  • B. Taylor Thompson
    • 2
  • David C. Christiani
    • 1
    • 2
    Email author
  1. 1.Department of Environmental HealthHarvard School of Public HealthBostonUSA
  2. 2.Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Division of Critical Care MedicineMontefiore Medical CenterBronxUSA
  4. 4.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  5. 5.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
  6. 6.Faculty of Respiratory Therapy, College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan

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