Influenza and associated co-infections in critically ill immunosuppressed patients

被引：22

作者：

Martin-Loeches, Ignacio ^{[11
,12
,43
]}

Lemiale, Virginie ^{[1
,2
]}

Geoghegan, Pierce ^{[11
,12
]}

McMahon, Mary Aisling ^{[11
,12
]}

Pickkers, Peter ^{[3
]}

Soares, Marcio ^{[4
,5
]}

Perner, Anders ^{[6
]}

Meyhoff, Tine Sylvest ^{[6
]}

Bukan, Ramin Brandt ^{[27
]}

Rello, Jordi ^{[7
]}

Bauer, Philippe R. ^{[8
]}

van de Louw, Andry ^{[9
]}

Taccone, Fabio Silvio ^{[10
]}

Salluh, Jorge ^{[4
,5
]}

Hemelaar, Pleun ^{[3
]}

Schellongowski, Peter ^{[13
]}

Rusinova, Katerina ^{[14
,15
,16
]}

Terzi, Nicolas ^{[18
]}

Mehta, Sangeeta ^{[19
,20
]}

Antonelli, Massimo ^{[21
]}

Kouatchet, Achille ^{[22
]}

Klepstad, Pal ^{[17
]}

Valkonen, Miia ^{[24
]}

Landburg, Precious Pearl ^{[25
]}

Barratt-Due, Andreas ^{[23
]}

Bruneel, Fabrice ^{[26
]}

Pene, Frederic ^{[28
,29
]}

Metaxa, Victoria ^{[30
]}

Moreau, Anne Sophie ^{[31
]}

Souppart, Virginie ^{[1
,2
]}

Burghi, Gaston ^{[32
]}

Girault, Christophe ^{[33
]}

Silva, Ulysses V. A. ^{[34
]}

Montini, Luca ^{[21
]}

Barbier, Francois ^{[35
]}

Nielsen, Lene B. ^{[36
,37
]}

Gaborit, Benjamin ^{[38
]}

Mokart, Djamel ^{[39
,40
]}

Chevret, Sylvie ^{[41
,42
]}

Azoulay, Elie ^{[1
,2
]}

机构：

[1] Hop St Louis, Med Intens Care Unit, Paris, France

[2] Paris Diderot Sorbonne Univ, Med Intens Care Unit, Paris, France

[3] Radboud Univ Nijmegen, Med Ctr, Dept Intens Care Med 710, Nijmegen, Netherlands

[4] DOr Inst Res & Educ, Dept Crit Care, Rio De Janeiro, Brazil

[5] DOr Inst Res & Educ, Programa Posgrad Clin Med, Grad Program Translat Med, Rio De Janeiro, Brazil

[6] Univ Copenhagen, Rigshosp, Dept Intens Care, Copenhagen, Denmark

[7] Univ Autonoma Barcelona, European Study Grp Infect Critically Ill Patients, CIBERES, Barcelona, Spain

[8] Mayo Clin, Pulm & Crit Care Med, Rochester, MN USA

[9] Penn State Univ, Coll Med, Div Pulm & Crit Care, Hershey, PA USA

[10] ULB, Hop Erasme, Dept Intens Care, Brussels, Belgium

[11] St James Hosp, MICRO, Dept Intens Care Med, Dublin, Ireland

[12] St James Hosp, Trinity Coll, Wellcome Trust HRB Clin Res Facil, Dept Clin Med, Dublin, Ireland

[13] Med Univ Vienna, Dept Med 1, Vienna, Austria

[14] Charles Univ Prague, Fac Med 1, Dept Anesthesiol & Intens Care Med, Prague, Czech Republic

[15] Charles Univ Prague, Fac Med 1, Inst Med Humanities, Prague, Czech Republic

[16] Gen Univ Hosp, Prague, Czech Republic

[17] Norwegian Univ Sci & Technol, Trondheim, Norway

[18] Univ Grenoble Alpes, CHU Grenoble Alpes, Fac Med Grenoble, Serv Reanimat Med,INSERM,U1042, Grenoble, France

[19] Univ Toronto, Sinai Hlth Syst, Dept Med, Toronto, ON, Canada

[20] Univ Toronto, Sinai Hlth Syst, Interdept Div Crit Care Med, Toronto, ON, Canada

[21] Univ Cattolica Sacro Cuore, Agostino Gemelli Univ Hosp, Rome, Italy

[22] Univ Hosp Angers, Dept Med Intens Care Med, Angers, France

[23] Univ Oslo, Dept Emergencies & Crit Care, Dept Immunol, Oslo, Norway

[24] Univ Helsinki, Helsinki Univ Hosp, Dept Anesthesiol Intens Care & Pain Med, Div Intens Care Med, Helsinki, Finland

[25] Univ Med Ctr Groningen, Dept Crit Care, Groningen, Netherlands

[26] Ctr Hosp Versailles, Med Surg Intens Care Unit, Le Chesnay, France

[27] Herlev Univ Hosp, Dept Anesthesiol 1, Herlev, Denmark

[28] Cochin Hosp, AP HP, Med ICU, Paris, France

[29] Univ Paris 05, Paris, France

[30] Kings Coll Hosp NHS Fdn Trust, Crit Care Dept, London SE5 9RS, England

[31] Univ Lille, Sch Med, CHU Lille, Crit Care Ctr, Lille, France

[32] Hosp Maciel, Terapia Intensiva, Montevideo, Uruguay

[33] Normandie Univ, Rouen Univ Hosp, UNIROUEN, Dept Med Intens Care,EA 3830, F-76000 Rouen, France

[34] Fundacao Pio XII Barretos Canc Hosp, ICU, Barretos, Brazil

[35] CHR Orleans, La Source Hosp, Med Intens Care Unit, Orleans, France

[36] Univ Southern Denmark, Intens Care Dept, Sonderborg, Denmark

[37] Odense Univ Hosp, Dept Anaesthesia & Intens Care, Odense, Denmark

[38] Univ Hosp Nantes, HME, Hotel Dieu, Med Intens Care Unit, Nantes, France

[39] Inst Paoli Calmettes, Reanimat Polyvalente, Marseille, France

[40] Inst Paoli Calmettes, Dept Anesthesie & Reanimat, Marseille, France

[41] Paris Diderot Sorbonne Univ, ECSTRA Team Biostat & Clin Epidemiol, INSERM, UMR 1153, St Louis, France

[42] Hop St Louis, AP HP, Serv Biostat & Informat Med, St Louis, France

[43] St James Hosp, Dept Intens Care Med, St Jamess St, Dublin 8, Ireland

来源：

CRITICAL CARE | 2019年 / 23卷 / 1期

关键词：

Influenza; Respiratory failure; Sepsis; Critical illness; Immunosuppression; BACTERIAL COINFECTION; RESPIRATORY-FAILURE; SEPSIS; MALIGNANCY; MANAGEMENT; PNEUMONIA; INFECTION; IMPACT;

D O I：

10.1186/s13054-019-2425-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundIt is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure.MethodsPreplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18years 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.ResultsInfluenza 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.ConclusionsCategory 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.

引用

页数：10

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