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Influenza and associated co-infections in critically ill immunosuppressed patients

I. Martin-Loeches, V. Lemiale, P. Geoghegan, MA. McMahon, P. Pickkers, M. Soares, A. Perner, TS. Meyhoff, RB. Bukan, J. Rello, PR. Bauer, A. van de Louw, FS. Taccone, J. Salluh, P. Hemelaar, P. Schellongowski, K. Rusinova, N. Terzi, S. Mehta, M....

. 2019 ; 23 (1) : 152. [pub] 20190502

Jazyk angličtina Země Velká Británie

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc19044848

Grantová podpora
Health Research Board - JPI-AMR-2018-001 Grant Contract- RPAMS 14748 Health Research Board - Ireland

BACKGROUND: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. METHODS: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. RESULTS: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. CONCLUSIONS: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.

Agostino Gemelli University Hospital Università Cattolica del Sacro Cuore Rome Italy

CHU Grenoble Alpes Service de Réanimation Médicale Faculté de Médecine de Grenoble INSERM U1042 Université Grenoble Alpes Grenoble France

CIBERES Universitat Autonòma de Barcelona European Study Group of Infections in Critically Ill Patients Barcelona Spain

Critical Care Center CHU Lille School of Medicine University of Lille Lille France

Critical Care Department King's College Hospital NHS Foundation Trust London SE5 9RS UK

Department of Anesthesiology 1 Herlev University Hospital Herlev Denmark

Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities 1st Faculty of Medicine Charles University Prague and General University Hospital Prague Czech Republic

Department of Critical Care and Graduate Program in Translational Medicine Programa de Pós Graduação em Clínica Médica D'Or Institute for Research and Education Rio de Janeiro Brazil

Department of Critical Care University Medical Center Groningen Groningen The Netherlands

Department of Immunology Department of Emergencies and Critical Care University of Oslo Oslo Norway

Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland Department of Clinical Medicine Wellcome Trust HRB Clinical Research Facility St James Hospital Trinity College Dublin Ireland

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland Department of Clinical Medicine Wellcome Trust HRB Clinical Research Facility St James Hospital Trinity College Dublin Ireland Department of Intensive Care Medicine St James's Hospital St James's St Dublin Dublin 8 Ireland

Department of Intensive Care Medicine Radboud University Medical Centre Nijmegen The Netherlands

Department of Intensive Care Rigshospitalet University of Copenhagen Copenhagen Denmark

Department of Medical Intensive Care Medicine University Hospital of Angers Angers France

Department of Medical Intensive Care Normandie Univ UNIROUEN EA 3830 Rouen University Hospital F 76000 Rouen France

Department of Medicine 1 Medical University of Vienna Vienna Austria

Department of Medicine and Interdepartmental Division of Critical Care Medicine Sinai Health System University of Toronto Toronto Ontario Canada

Division of Intensive Care Medicine Department of Anesthesiology Intensive Care and Pain Medicine Helsinki University Hospital University of Helsinki Helsinki Finland

Division of Pulmonary and Critical Care Penn State University College of Medicine Hershey PA USA

ECSTRA Team Biostatistics and Clinical Epidemiology UMR 1153 INSERM Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP HP Hôpital Saint Louis Saint Louis France

ICU Fundação Pio XII Barretos Cancer Hospital Barretos Brazil

Intensive Care Department University of Southern Denmark Sønderborg Denmark Department of Anaesthesia and Intensive Care Odense University Hospital Odense Denmark

Medical ICU Cochin Hospital Assistance Publique Hôpitaux de Paris and University Paris Descartes Paris France

Medical Intensive Care Unit Hôpital Saint Louis and Paris Diderot Sorbonne University Paris France

Medical Intensive Care Unit Hôtel Dieu HME University Hospital of Nantes Nantes France

Medical Intensive Care Unit La Source Hospital CHR Orléans Orléans France

Medical Surgical Intensive Care Unit Centre Hospitalier de Versailles Le Chesnay France

Norwegian University of Science and Technology Trondheim Norway

Pulmonary and Critical Care Medicine Mayo Clinic Rochester MN USA

Réanimation Polyvalente et Département d'Anesthésie et de Réanimation Institut Paoli Calmettes Marseille France

Terapia Intensiva Hospital Maciel Montevideo Uruguay

Citace poskytuje Crossref.org

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$a Martin-Loeches, Ignacio $u Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. drmartinloeches@gmail.com. Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland. drmartinloeches@gmail.com. Department of Intensive Care Medicine, St. James's Hospital, St. James's St, Dublin, Dublin 8, Ireland. drmartinloeches@gmail.com.
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$a Influenza and associated co-infections in critically ill immunosuppressed patients / $c I. Martin-Loeches, V. Lemiale, P. Geoghegan, MA. McMahon, P. Pickkers, M. Soares, A. Perner, TS. Meyhoff, RB. Bukan, J. Rello, PR. Bauer, A. van de Louw, FS. Taccone, J. Salluh, P. Hemelaar, P. Schellongowski, K. Rusinova, N. Terzi, S. Mehta, M. Antonelli, A. Kouatchet, P. Klepstad, M. Valkonen, PP. Landburg, A. Barratt-Due, F. Bruneel, F. Pène, V. Metaxa, AS. Moreau, V. Souppart, G. Burghi, C. Girault, UVA. Silva, L. Montini, F. Barbier, LB. Nielsen, B. Gaborit, D. Mokart, S. Chevret, E. Azoulay, Efraim investigators and the Nine-I study group,
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$a BACKGROUND: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. METHODS: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. RESULTS: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. CONCLUSIONS: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.
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$a Lemiale, Virginie $u Medical Intensive Care Unit, Hôpital Saint-Louis and Paris Diderot Sorbonne University, Paris, France.
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$a Geoghegan, Pierce $u Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland.
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$a McMahon, Mary Aisling $u Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland. Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital, Trinity College, Dublin, Ireland.
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$a Pickkers, Peter $u Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands.
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$a Perner, Anders $u Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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$a Meyhoff, Tine Sylvest $u Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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$a Bukan, Ramin Brandt $u Department of Anesthesiology I, Herlev University Hospital, Herlev, Denmark.
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$a Rello, Jordi $u CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain.
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$a Bauer, Philippe R $u Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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$a van de Louw, Andry $u Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA.
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$a Taccone, Fabio Silvio $u Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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$a Hemelaar, Pleun $u Department of Intensive Care Medicine (710), Radboud University Medical Centre, Nijmegen, The Netherlands.
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$a Schellongowski, Peter $u Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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$a Terzi, Nicolas $u CHU Grenoble Alpes, Service de Réanimation Médicale, Faculté de Médecine de Grenoble, INSERM U1042, Université Grenoble-Alpes, Grenoble, France.
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$a Mehta, Sangeeta $u Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, Ontario, Canada.
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$a Antonelli, Massimo $u Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
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$a Valkonen, Miia $u Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
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$a Landburg, Precious Pearl $u Department of Critical Care, University Medical Center Groningen, Groningen, The Netherlands.
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$a Barratt-Due, Andreas $u Department of Immunology-Department of Emergencies and Critical Care, University of Oslo, Oslo, Norway.
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$a Bruneel, Fabrice $u Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France.
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$a Pène, Frédéric $u Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes, Paris, France.
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$a Metaxa, Victoria $u Critical Care Department, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
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$a Moreau, Anne Sophie $u Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France.
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$a Nielsen, Lene B $u Intensive Care Department, University of Southern Denmark, Sønderborg, Denmark. Department of Anaesthesia and Intensive Care, Odense University Hospital, Odense, Denmark.
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$a Gaborit, Benjamin $u Medical Intensive Care Unit, Hôtel Dieu-HME-University Hospital of Nantes, Nantes, France.
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$a Mokart, Djamel $u Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
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$a Chevret, Sylvie $u ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153, INSERM, Paris Diderot Sorbonne University and Service de Biostatistique et Information Médicale AP-HP, Hôpital Saint-Louis, Saint-Louis, France.
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