Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. - Archive ouverte HAL Access content directly
Journal Articles Intensive Care Med Year : 2010

Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models.

(1) , (1, 2) , (3) , (4) , (3, 5) , (6) , (7) , (8) , (9) , (10) , (11) , (12) , (13)
1
2
3
4
5
6
7
8
9
10
11
12
13

Abstract

PURPOSE: Methods for estimating the excess mortality attributable to ventilator-associated pneumonia (VAP) should handle VAP as a time-dependent covariate, since the probability of experiencing VAP increases with the time on mechanical ventilation. VAP-attributable mortality (VAP-AM) varies with definitions, case-mix, causative microorganisms, and treatment adequacy. Our objectives here were to compare VAP-AM estimates obtained using a traditional cohort analysis, a multistate progressive disability model, and a matched-cohort analysis; and to compare VAP-AM estimates according to VAP characteristics. METHODS: We used data from 2,873 mechanically ventilated patients in the Outcomerea((R)) database. Among these patients from 12 intensive care units, 434 (15.1%) experienced VAP; of the remaining patients, 1,969 (68.5%) were discharged alive and 470 (16.4%) died. With the multistate model, VAP-AM was 8.1% (95% confidence interval [95%CI], 3.1-13.1%) for 120 days' complete observation, compared to 10.4% (5.6-24.5%) using a matched-cohort approach (2,769 patients) with matching on mechanical ventilation duration followed by conditional logistic regression. VAP-AM was higher in surgical patients and patients with intermediate (but not high) Simplified Acute Physiologic Score II values at ICU admission. VAP-AM was significantly influenced by time to VAP but not by resistance of causative microorganisms. Higher Logistic Organ Dysfunction score at VAP onset dramatically increased VAP-AM (to 31.9% in patients with scores above 7). CONCLUSION: A multistate model that appropriately handled VAP as a time-dependent event produced lower VAP-AM values than conditional logistic regression. VAP-AM varied widely with case-mix. Disease severity at VAP onset markedly influenced VAP-AM; this may contribute to the variability of previous estimates.

Dates and versions

inserm-00465413 , version 1 (19-03-2010)

Identifiers

Cite

Molière Nguile-Makao, Jean-Ralph Zahar, Adrien Français, Alexis Tabah, Maïté Garrouste-Orgeas, et al.. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models.. Intensive Care Med, 2010, epub ahead of print. ⟨10.1007/s00134-010-1824-6⟩. ⟨inserm-00465413⟩
137 View
0 Download

Altmetric

Share

Gmail Facebook Twitter LinkedIn More