Influenza and associated co-infections in critically ill immunosuppressed patients
Martin-Loeches, Ignacio (St. James's Hospital ( Dublín, Irlanda))
Lemiale, Virginie (Hôpital Saint-Louis and Paris Diderot Sorbonne University. Medical Intensive Care Unit)
Geoghegan, Pierce (Trinity College. Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital)
McMahon, Mary Aisling (Trinity College. Department of Clinical Medicine, Wellcome Trust-HRB Clinical Research Facility, St. James Hospital)
Pickkers, Peter (Radboud University Medical Centre. Department of Intensive Care Medicine)
Soares, Marcio (D'Or Institute for Research and Education (Rio de Janeiro, Brasil))
Perner, Anders (University of Copenhagen)
Meyhoff, Tine Sylvest (University of Copenhagen)
Bukan, Ramin Brandt (Herlev University Hospital. Department of Anesthesiology I)
Rello, Jordi (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Bauer, Philippe (Mayo Clinic. Pulmonary and Critical Care Medicine)
van de Louw, Andry (Penn State University College of Medicine. Division of Pulmonary and Critical Care)
Taccone, Fabio Silvio (Université Libre de Bruxelles (ULB). Department of Intensive Care, Hôpital Erasme)
Salluh, Jorge (D'Or Institute for Research and Education (Rio de Janeiro, Brasil))
Hemelaar, Pleun (Radboud University Medical Centre. Department of Intensive Care Medicine)
Schellongowski, Peter (Medical University of Vienna. Department of Medicine I)
Rusinova, Katerina (Charles University. Faculty of Medicine in Hradec Králové)
Terzi, Nicolas (Université Grenoble-Alpes. CHU Grenoble Alpes, Service de Réanimation Médicale, Faculté de Médecine de Grenoble, INSERM U1042)
Mehta, Sangeeta (University of Toronto. Department of Medicine)
Antonelli, Massimo (Università Cattolica del Sacro Cuore. Agostino Gemelli University Hospital)
Kouatchet, Achille (University Hospital of Angers. Department of Medical Intensive Care Medicine)
Klepstad, Pål (Norwegian University of Science and Technology)
Valkonen, Miia (Helsinki University Hospital (Finlàndia))
Landburg, Precious Pearl (University Medical Center Groningen. Department of Critical Care)
Barratt-Due, Andreas (University of Oslo. Department of Immunology-Department of Emergencies and Critical Care)
Bruneel, Fabrice (Centre Hospitalier de Versailles. Medical-Surgical Intensive Care Unit)
Pène, Frédéric (Medical ICU, Cochin Hospital, Assistance Publique-Hôpitaux de Paris and University Paris Descartes)
Metaxa, Victoria (King's College Hospital NHS Foundation Trust)
Moreau, Anne Sophie (University of Lille. Critical Care Center, CHU Lille, School of Medicine)
Souppart, Virginie (Hôpital Saint-Louis and Paris Diderot Sorbonne University. Medical Intensive Care Unit)
Burghi, Gastón (Hospital Maciel. Terapia Intensiva)
Girault, Christophe (Normandie Univ, UNIROUEN, EA-3830, Rouen University Hospital. Department of Medical Intensive Care)
Silva, Ulysses V. A. (ICU, Fundação Pio XII - Barretos Cancer Hospital)
Montini, Luca (Università Cattolica del Sacro Cuore. Agostino Gemelli University Hospital)
Barbier, Francois (La Source Hospital - CHR Orléans. Medical Intensive Care Unit)
Nielsen, Lene B. (Odense University Hospital (Dinamarca))
Gaborit, Benjamin (CHU de Nantes)
Mokart, Djamel (Institut Paoli-Calmettes. Réanimation Polyvalente et Département d'Anesthésie et de Réanimation)
Chevret, Sylvie (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)
Azoulay, Elie (Hôpital Saint-Louis and Paris Diderot Sorbonne University. Medical Intensive Care Unit)
Universitat Autònoma de Barcelona

Date:	2019
Abstract:	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. 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. 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. 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. The online version of this article (10. 1186/s13054-019-2425-6) contains supplementary material, which is available to authorized users.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Influenza ; Respiratory failure ; Sepsis ; Critical illness ; Immunosuppression
Published in:	Critical Care, Vol. 23 (may 2019) , ISSN 1466-609X

DOI: 10.1186/s13054-019-2425-6
PMID: 31046842

10 p, 1.2 MB

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