Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis
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,
Ignacio Martin-Loeches
Affiliations
Luis Felipe Reyes
Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia 250001, Colombia
Antoni Torres
School of Medicine, University of Barcelona, 08036 Barcelona, Spain
Juan Olivella-Gomez
Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia 250001, Colombia
Elsa D. Ibáñez-Prada
Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia 250001, Colombia
Saad Nseir
Médecine Intensive-Réanimation, Hôpital R. Salengro, CHU de Lille, 59037 Lille, France
Otavio T. Ranzani
Barcelona Institute for Global Health, ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
Pedro Povoa
NOVA Medical School, NOVA University of Lisbon, 1169-056 Lisbon, Portugal
Emilio Diaz
School of Medicine, Corporació Sanitaria Parc Tauli, 08208 Sabadell, Spain
Marcus J. Schultz
Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 Amsterdam, The Netherlands
Alejandro H. Rodríguez
Hospital Joan XXIII de Tarragona, 43003 Tarragona, Spain
Cristian C. Serrano-Mayorga
Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia 250001, Colombia
Gennaro De Pascale
Department of Intensive Care and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Paolo Navalesi
School of Medicine, Magna Graecia University, 88100 Catanzaro, Italy
Szymon Skoczynski
Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-803 Katowice, Poland
Mariano Esperatti
Hospital Privado de Comunidad, Escuela Superior de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata 7600, Argentina
Luis Miguel Coelho
NOVA Medical School, NOVA University of Lisbon, 1169-056 Lisbon, Portugal
Andrea Cortegiani
Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy
Stefano Aliberti
School of Medicine, Medical University of Silesia, 41-902 Katowise, Poland
Anselmo Caricato
Department of Intensive Care and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Helmut J. F. Salzer
Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine 4—Pneumology, Kepler University Hospital, 4020 Linz, Austria
Adrian Ceccato
School of Medicine, University of Barcelona, 08036 Barcelona, Spain
Rok Civljak
“Dr Fran Mihaljevic” University Hospital for Infectious Diseases, 10000 Zagreb, Croatia
Paolo Maurizio Soave
Department of Intensive Care and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Charles-Edouard Luyt
Service de Médecine Intensive Réanimation, Sorbonne Université, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, 75013 Paris, France
Pervin Korkmaz Ekren
Medical Faculty, Ege University, 35100 Izmir, Turkey
Fernando Rios
Hospital Nacional Alejandro Posadas, El Palomar 1704, Argentina
Joan Ramon Masclans
Critical Care Department, Hospital del Mar, GREPAC, Hospital del Mar Research Institute, MELIS, Universitat Pompeu Fabra, 08003 Barcelona, Spain
Judith Marin
Hospital del Mar, 08003 Barcelona, Spain
Silvia Iglesias-Moles
Hospital Arnau de Vilanova de Lleida, 25198 Lleida, Spain
Stefano Nava
Universita Alma Mater Studiorum Bologna Pneumologia e Terapia Intensiva Respiratoria, IRCCS Ospedale di Sant’Orsola, 40138 Bologna, Italy
Davide Chiumello
ASST Santi Paolo e Carlo, 20142 Milan, Italy
Lieuwe D. Bos
Intensive Care, Amsterdam UMC, University of Amsterdam, 1105 Amsterdam, The Netherlands
Antonio Artigas
Ntensive Care Medicine Department, Corporacion Sanitaria Universitaria Parc Tauli, Institut d’Investigació I Innovació Parc Tauli I3PT, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, 08208 Sabadell, Spain
Filipe Froes
Chest Department, Hospital Pulido Valente, CHULN, 1769-001 Lisbon, Portugal
David Grimaldi
Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
Mauro Panigada
Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20100 Milan, Italy
Fabio Silvio Taccone
Hopital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
Massimo Antonelli
Department of Intensive Care and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Ignacio Martin-Loeches
St James’s University Hospital, Trinity College, D08 NHY1 Dublin, Ireland
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.