c48f0412c09535620be25ea13ef2ac0f 309079.pdf 42d0590380640720ed6db612b3cff8e39a453798 309079.pdf 9641da61dc6e795c53883d34ff9cd7298d77fba5626f3a905bbba5b9170f1757 309079.pdf Title: Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis Subject: Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. Keywords: critical care; mechanical ventilation; nosocomial lower respiratory tract infections Author: Luis Felipe Reyes, Antoni Torres, Juan Olivella-Gomez, Elsa D. Ibáñez-Prada, Saad Nseir, Otavio T. Ranzani, Pedro Povoa, Emilio Diaz, Marcus J. Schultz, Alejandro H. Rodríguez, Cristian C. Serrano-Mayorga, Gennaro De Pascale, Paolo Navalesi, Szymon Skoczynski, Mariano Esperatti, Luis Miguel Coelho, Andrea Cortegiani, Stefano Aliberti, Anselmo Caricato, Helmut J. F. Salzer, Adrian Ceccato, Rok Civljak, Paolo Maurizio Soave, Charles-Edouard Luyt, Pervin Korkmaz Ekren, Fernando Rios, Joan Ramon Masclans, Judith Marin, Silvia Iglesias-Moles, Stefano Nava, Davide Chiumello, Lieuwe D. Bos, Antonio Artigas, Filipe Froes, David Grimaldi, Mauro Panigada, Fabio Silvio Taccone, Massimo Antonelli and Ignacio Martin-Loeches Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Sun Jan 26 07:38:59 2025 CET ModDate: Sun Jan 26 07:43:21 2025 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 17 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 569836 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- QGYAWM+SFRM0800 Type 1 Custom yes yes yes 10 0 GHTBWD+VnURWPalladioL Type 1 Custom yes yes yes 16 0 CAEPWI+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 TBALLU+URWPalladioL-Bold Type 1 Custom yes yes yes 28 0 JHXLJS+URWPalladioL-Ital Type 1 Custom yes yes yes 33 0 LWLIVD+EURM10 Type 1 Builtin yes yes yes 62 0 GQWIGS+CMSY10 Type 1 Builtin yes yes yes 67 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes yes 75 0 DHHGEL+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 87 0 DHHFCJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 90 0 DHHFCL+PalatinoLinotype TrueType WinAnsi yes yes no 93 0 DHHFCN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 96 0 DHHFMM+PalatinoLinotype TrueType MacRoman yes yes no 99 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-03-12 02:42:20 CET RepresentationInformation: 309079.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-03-11 17:11:08 CET Size: 569836 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 291 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Results Destination: section.2 Children: Item: Title: Mortality Analysis in the Whole Cohort Destination: subsection.2.1 Item: Title: Mortality Stratified by Ventilation Status Destination: subsection.2.2 Item: Title: Discussion Destination: section.3 Item: Title: Materials and Methods Destination: section.4 Children: Item: Title: Definitions Destination: subsection.4.1 Item: Title: Data Collection Destination: subsection.4.2 Item: Title: Clustering Patients by Shared Demographic and Clinical Characteristics to Enhance Model Accuracy and Generalizability Destination: subsection.4.3 Item: Title: Statistical Analysis Destination: subsection.4.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis Author: Luis Felipe Reyes, Antoni Torres, Juan Olivella-Gomez, Elsa D. Ibáñez-Prada, Saad Nseir, Otavio T. Ranzani, Pedro Povoa, Emilio Diaz, Marcus J. Schultz, Alejandro H. Rodríguez, Cristian C. Serrano-Mayorga, Gennaro De Pascale, Paolo Navalesi, Szymon Skoczynski, Mariano Esperatti, Luis Miguel Coelho, Andrea Cortegiani, Stefano Aliberti, Anselmo Caricato, Helmut J. F. Salzer, Adrian Ceccato, Rok Civljak, Paolo Maurizio Soave, Charles-Edouard Luyt, Pervin Korkmaz Ekren, Fernando Rios, Joan Ramon Masclans, Judith Marin, Silvia Iglesias-Moles, Stefano Nava, Davide Chiumello, Lieuwe D. Bos, Antonio Artigas, Filipe Froes, David Grimaldi, Mauro Panigada, Fabio Silvio Taccone, Massimo Antonelli and Ignacio Martin-Loeches Subject: Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28 6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13 3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06 5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. 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