Impact of Pathogen Status on Sepsis-Associated Acute Respiratory Distress Syndrome Outcomes

BACKGROUND Sepsis-associated acute respiratory distress syndrome (ARDS) has a high incidence and mortality, and the characteristic differences between positive and negative results for pathogenic microorganisms with sepsis-associated ARDS remain unclear. This study explored differences in the characteristics of patients with sepsis-associated ARDS with positive and negative results for pathogenic microorganisms. MATERIAL AND METHODS The study was a retrospective cohort study. We searched the population for sepsis-associated ARDS from the Medical Information Mart for Intensive Care IV (MIMIC IV) and electronic Intensive Care Unit (eICU) databases. The objective of this study was to compare the characteristics and prognosis of patients with sepsis with pathogenic microorganisms-associated ARDS using non-parametric tests, Wilcoxon, univariate, and multivariate COX regression analyses, receiver operating characteristic (ROC) curves, and other methods. RESULTS Compared with pathogenic microbial-negative sepsis-associated ARDS, patients with pathogenic microbial-positive sepsis-associated ARDS had worse oxygenation indices and prognosis, lower levels of PaO₂, PaO₂/FiO₂, SpO₂/FiO₂, and SpO₂/FiO₂*respiratory rate, and a higher mortality rate at 28 days and 90 days. Age, INR, lactate level, Acinetobacter baumannii infection, continuous renal replacement therapy treatment, and SOFA score were independent risk factors for mortality in patients with pathogenic microorganism-positive sepsis-associated ARDS. In particular, patients with sepsis-associated ARDS infected with A. baumannii had a worse prognosis. After fitting the above risk factors into the model, the prognostic evaluation ability of ARDS associated with positive pathogenic microorganisms was significantly improved. CONCLUSIONS Patients with pathogenic microorganism-positive sepsis-associated ARDS, especially those with A. baumannii infection, had a poor prognosis and should receive timely attention in clinical practice.