Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies
(2013) In The Lancet. Infectious Diseases 13(8). p.665-671- Abstract
- Background Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical... (More)
- Background Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1.13 (95% CI 0.98-1.31). The overall daily risk of discharge after ventilator-associated pneumonia was 0.74 (0-68-0.80), leading to an overall cumulative risk for dying in the ICU of 2.20 (1.91-2.54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2.97,95% CI 2-24-3-94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2.49 [1.81-3-44] for patients with APACHE scores of 20-29 and 2.72 [1.95-3.78] for those with SAPS 2 scores of 35-58). Interpretation The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay. (Less)
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- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- in
- The Lancet. Infectious Diseases
- volume
- 13
- issue
- 8
- pages
- 665 - 671
- publisher
- Elsevier
- external identifiers
-
- wos:000322296500031
- scopus:84880702331
- ISSN
- 1474-4457
- DOI
- 10.1016/S1473-3099(13)70081-1
- language
- English
- LU publication?
- yes
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- df8b4522-b9d2-4068-9dc0-56e9c2e47d7f (old id 4042833)
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@article{df8b4522-b9d2-4068-9dc0-56e9c2e47d7f,
abstract = {{Background Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1.13 (95% CI 0.98-1.31). The overall daily risk of discharge after ventilator-associated pneumonia was 0.74 (0-68-0.80), leading to an overall cumulative risk for dying in the ICU of 2.20 (1.91-2.54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2.97,95% CI 2-24-3-94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2.49 [1.81-3-44] for patients with APACHE scores of 20-29 and 2.72 [1.95-3.78] for those with SAPS 2 scores of 35-58). Interpretation The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay.}},
author = {{Melsen, Wilhelmina G. and Rovers, Maroeska M. and Groenwold, Rolf H. H. and Bergmans, Dennis C. J. J. and Camus, Christophe and Bauer, Torsten T. and Hanisch, Ernst W. and Klarin, Bengt and Koeman, Mirelle and Krueger, Wolfgang A. and Lacherade, Jean-Claude and Lorente, Leonardo and Memish, Ziad A. and Morrow, Lee E. and Nardi, Giuseppe and van Nieuwenhoven, Christianne A. and O'Keefe, Grant E. and Nakos, George and Scannapieco, Frank A. and Seguin, Philippe and Staudinger, Thomas and Topeli, Arzu and Ferrer, Miguel and Bonten, Marc J. M.}},
issn = {{1474-4457}},
language = {{eng}},
number = {{8}},
pages = {{665--671}},
publisher = {{Elsevier}},
series = {{The Lancet. Infectious Diseases}},
title = {{Attributable mortality of ventilator-associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies}},
url = {{http://dx.doi.org/10.1016/S1473-3099(13)70081-1}},
doi = {{10.1016/S1473-3099(13)70081-1}},
volume = {{13}},
year = {{2013}},
}