Shichao Zhu1, Wen Wang2, Yan Kang3, Qiao He2, Hui Zhang1, Yuhua Deng1, Lin Cai3, Rui Zhang4, Xin Sun2, Zhiyong Zong1,5. 1. Department of Infection Control, West China Hospital of Sichuan University, Chengdu, China. 2. Chinese Evidence-Based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, China. 3. Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China. 4. Information Center, West China Hospital of Sichuan University, Chengdu, China. 5. Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
Abstract
OBJECTIVE: To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry. DESIGN: A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018. SETTING: The study was conducted using data from 5 adult ICUs of a referral hospital. PATIENTS: Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days. METHODS: Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses. RESULTS: Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU. CONCLUSIONS: Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.
OBJECTIVE: To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry. DESIGN: A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018. SETTING: The study was conducted using data from 5 adult ICUs of a referral hospital. PATIENTS: Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days. METHODS: Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses. RESULTS: Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU. CONCLUSIONS: Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.
Authors: Victor Daniel Rosenthal; Ruijie Yin; Sandra Liliana Valderrama-Beltran; Sandra Milena Gualtero; Claudia Yaneth Linares; Guadalupe Aguirre-Avalos; Julio Cesar Mijangos-Méndez; Miguel Ángel Ibarra-Estrada; Luisa Fernanda Jimenez-Alvarez; Lidia Patricia Reyes; Carlos Arturo Alvarez-Moreno; Maria Adelia Zuniga-Chavarria; Ana Marcela Quesada-Mora; Katherine Gomez; Johana Alarcon; Jose Millan Oñate; Daisy Aguilar-De-Moros; Elizabeth Castaño-Guerra; Judith Córdoba; Alejandro Sassoe-Gonzalez; Claudia Marisol Millán-Castillo; Lissette Leyva Xotlanihua; Lina Alejandra Aguilar-Moreno; Juan Sebastian Bravo Ojeda; Ivan Felipe Gutierrez Tobar; Mary Cruz Aleman-Bocanegra; Clara Veronica Echazarreta-Martínez; Belinda Mireya Flores-Sánchez; Yuliana Andrea Cano-Medina; Edwin Giovannny Chapeta-Parada; Rafael Antonio Gonzalez-Niño; Maria Isabel Villegas-Mota; Mildred Montoya-Malváez; Miguel Ángel Cortés-Vázquez; Eduardo Alexandrino Medeiros; Dayana Fram; Daniela Vieira-Escudero; Zhilin Jin Journal: J Epidemiol Glob Health Date: 2022-10-05