Up to 10% of acute lung injuries may be drug-related

A population-based study has found that drug-induced acute lung injury (DALI) accounts for around 9.5% of all acute lung injury (ALI) cases.

It is one of only a few studies to estimate the incidence of the condition, which has mainly been reported in case studies in the past.

"In this population-based cohort of patients with ALI, exposure to potentially injurious drugs was common and was associated with a history of malignancy, higher severity of illness, and worse clinical outcomes," say Rajanigandha Dhokarh (Lahey Clinic, Burlington, Minnesota, USA) and colleagues.

They used data from 8034 patients who were admitted to an intensive care unit in Olmsted County, Minnesota between January 2001 and December 2008.

The authors identified 514 patients with ALI, of which 12 were classified as probable DALI, and 37 as possible DALI.

Dhokarh and colleagues looked specifically at chemotherapeutic/anti-inflammatory agents, amiodarone, and nitrofurantoin, which are already known to cause ALI. The median time since last exposure to the suspected drug and the development of DALI was 2 days.

DALI was associated with significantly higher intensive care unit and hospital mortality, at 35% and 63%, respectively, than non-DALI admissions, at corresponding rates of 20% and 32%.

The team also found that patients with DALI had significantly more severe illness, with APACHE [Acute Physiology and Chronic Health Evaluation] III scores of 81 in the probable DALI group, and 83 in the possible DALI group, compared with 70 in the non-DALI group. The DALI group also had a higher burden of malignancy.

However, after adjusting for both these factors, regression analysis showed that DALI still increased the odds for hospital mortality 2.8-fold in comparison with non-DALI patients.

"Drugs are important risk factors for ALI and must be recognized as relevant causative agents, especially when used in combination and/or in the presence of other risk factors for ALI," write Dhokarh and colleagues in Chest.

"This may be useful to identify patients at high risk of DALI who require close monitoring, to facilitate early discontinuation of offending agents, and to develop strategies for limiting lung damage."

The authors say that their study is the first to provide an overall estimate of the incidence of DALI. However, they acknowledge several limitations, meaning that further research is needed: "Based on our results, further studies using a matched-case control design are warranted to further explore the relation between specific drugs and ALI."

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