Skip to content
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Menu
Home
About Us
Resources
Profiles Metrics
Authors Directory
Institutions Directory
Top Authors
Top Institutions
Top Sponsors
AI Digest
Contact Us
Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies
The Lancet Infectious Diseases, Volume 13, No. 8, Year 2013
Notification
URL copied to clipboard!
Description
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. Funding: None. © 2013 Elsevier Ltd.
Authors & Co-Authors
Melsen, Wilhelmina G.
Netherlands, Utrecht
University Medical Center Utrecht
Rovers, Maroeska M.
Netherlands, Utrecht
University Medical Center Utrecht
Netherlands, Nijmegen
Radboud University Medical Center
Groenwold, Rolf H.H.
Netherlands, Utrecht
University Medical Center Utrecht
Bergmans, Dennis C.J.J.
Netherlands, Maastricht
Universiteit Maastricht
Camus, Christophe M.
France, Rennes
Serv. Reanimat. Med.
Bauer, Torsten Thomas
Spain, Barcelona
Universitat de Barcelona
Hanisch, Ernst W.
Germany, Berlin
Helios Klinikum Emil Von Behring
Klarin, Bengt
Germany, Frankfurt am Main
Goethe-universität Frankfurt am Main
Koeman, Mirelle
Sweden, Lund
Skånes Universitetssjukhus
Krüeger, Wolfgang Artur
Netherlands, Utrecht
University Medical Center Utrecht
Lacherade, J. C.
Netherlands, The Hague
Hagaziekenhuis
Lorente, Leonardo
Germany, Tubingen
Universitätsklinikum Und Medizinische Fakultät Tübingen
Al Memish, Ziad Ahmed
Germany, Konstanz
Klinikum Konstanz
Morrow, Lee E.
France, La Roche-sur-yon
Service D'hématologie Clinique du Chd de la Roche-sur-yon
Nardi, Giuseppe
Spain, Santa Cruz de Tenerife
Hospital Universitario de Canarias
van Nieuwenhoven, Christianne A.
Saudi Arabia, Riyadh
King Fahad National Guard Hospital
O'Keefe, Grant E.
Saudi Arabia, Riyadh
Ministry of Health Saudi Arabia
Nakos, George
United States, Omaha
Creighton University Medical Center
Scannapieco, Frank A.
Italy, Udine
Presidio Ospedaliero Universitario Santa Maria Della Misericordia , Udine
United States, Buffalo
University at Buffalo, the State University of new York
Seguin, Philippe O.
Italy, Rome
Azienda Ospedaliera San Camillo Forlanini
France, Rennes
Hôpital Pontchaillou
Staudinger, Thomas
Netherlands, Maastricht
Maastricht Universitair Medisch Centrum+
Austria, Vienna
Medizinische Universität Wien
Topeli, Arzu
Netherlands, Rotterdam
Erasmus Mc
Turkey, Ankara
Hacettepe Üniversitesi
Ferrer, Miquel
United States, Seattle
Harborview Medical Center
Spain, Barcelona
Institut D'investigacions Biomèdiques August pi I Sunyer - Idibaps
Bonten, Marc J.M.
Netherlands, Utrecht
University Medical Center Utrecht
Greece, Ioannina
University General Hospital of Ioannina
Statistics
Citations: 658
Authors: 24
Affiliations: 27
Identifiers
Doi:
10.1016/S1473-3099(13)70081-1
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Environmental
Health System And Policy
Study Approach
Systematic review