Title
Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort
Date Issued
01 December 2021
Access level
open access
Resource Type
journal article
Author(s)
Nseir S.
Martin-Loeches I.
Povoa P.
Metzelard M.
Du Cheyron D.
Lambiotte F.
Tamion F.
Labruyere M.
Makris D.
Boulle Geronimi C.
Pinetonde Chambrun M.
Nyunga M.
Pouly O.
Mégarbane B.
Saade A.
Gomà G.
Magira E.
Llitjos J.F.
Torres A.
Ioannidou I.
Pierre A.
Coelho L.
Reignier J.
Garot D.
Kreitmann L.
Baudel J.L.
Voiriot G.
Contou D.
Beurton A.
Asfar P.
Boyer A.
Thille A.W.
Mekontso-Dessap A.
Tsolaki V.
Vinsonneau C.
Floch P.E.
Le Guennec L.
Ceccato A.
Artigas A.
Bouchereau M.
Labreuche J.
Duhamel A.
Rouzé A.
Favory R.
Préau S.
Jourdain M.
Poissy J.
Leger P.S.
Van der Linden T.
Veinstein A.
Azoulay E.
Pene F.
Martin M.
Razazi K.
Plantefeve G.
Fartoukh M.
Thevenin D.
Guidet B.
Weiss N.
Kouatchet A.
Salmon C.
Brunin G.
Nemlaghi S.
Meguerditchian D.
Argaud L.
Voicu S.
Luyt C.E.
Kowalski B.
Moglia E.
Morales L.
Koutsoukou A.
Mentzelopoulos S.D.
Nora D.
Boyd S.
Maizel J.
Cuchet P.
Delforge Q.
Quenot J.P.
Boyer D.
Publisher(s)
BioMed Central Ltd
Abstract
Background: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16–2.47), p = 0.006), and influenza groups (1.75 (1.03–3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64–1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. Clinical trial registration: The study was registered at ClinicalTrials.gov, number NCT04359693.
Volume
25
Issue
1
Language
English
OCDE Knowledge area
Epidemiología
Enfermedades infecciosas
Subjects
Scopus EID
2-s2.0-85106945075
PubMed ID
Source
Critical Care
ISSN of the container
13648535
Sponsor(s)
AR received personal fees from MaatPharma, IML received personal fees from MSD, and Gilead. AA received personal fees from Lilly Foundation, and grants from Grifols and Fischer & Paykel. CEL received personal fees from Bayer, Merck, Aerogen, Biomérieux, ThermoFischer Brahms, and Carmat. SN received personal fees from MSD, Bio Rad, BioMérieux, Gilead, and Pfizer. All other authors declare no competing interests.
This study was supported in part by a grant from the French government through the «Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpretation, writing of the report, or decision to submit for publication.
In addition to the authors, the coVAPid study group includes the following collaborators : Raphaël Favory: CHU de Lille, Centre de Réanimation, F-59000 Lille, France. Sébastien Préau: CHU de Lille, Centre de Réanimation, F-59000 Lille, France. Mercé Jourdain: CHU de Lille, Centre de Réanimation, F-59000 Lille, France. Julien Poissy: CHU de Lille, Centre de Réanimation, F-59000 Lille, France. Piehr Saint Leger: Service de Réanimation polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France. Thierry Van der Linden: Médecine intensive réanimation, Hôpital Saint Philibert GHICL, Université catholique, Lille, France. Anne Veinstein: CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France. Elie Azoulay: Service de médecine intensive et réanimation, hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France. Frédéric Pene: Medical Intensive Care Unit, Cochin Hospital, AP-HP. Centre, & Université de Paris, Paris, France. Maelle Martin: Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France. Keyvan Razazi: Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de réanimation médicale, Créteil, France. Gaëtan Plantefeve: Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France. Muriel Fartoukh: Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France. Didier Thevenin: Réanimation polyvalente CH Lens, France. Bertrand Guidet: Service de Médecine Intensive Réanimation, AP-HP, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Paris, 75571 Cedex 12, France. Nicolas Weiss: Sorbonne Université, AP-HP, Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Paris, France. Achille Kouatchet: Département de Médecine Intensive-Réanimation, CHU d'Angers, Université d'Angers, 4 rue Larrey, 49933, Angers Cedex 9, France. Charlotte Salmon: Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 2 Bd Tonnellé, 37000 Tours, France. Guillaume Brunin: Service de réanimation, hôpital Duchenne, rue Monod, 62200 Boulogne-sur-Mer, France. Safaa Nemlaghi: Service de Pneumologie, Médecine intensive - Réanimation (Département "R3S"), AP-HP, Sorbonne Université, Groupe Hospitalier Universitaire Pitié-Salpêtrière Charles Foix, 75013, Paris, France. David Meguerditchian: Intensive Care Unit, Pellegrin-Tripode Hospital, University Hospital of Bordeaux, Bordeaux, France. Laurent Argaud: Service de Médecine Intensive - Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5, place d'Arsonval, 69437, Lyon Cedex 03, France. Sebastian Voicu: Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Université de Paris, INSERM UMRS-1144, Paris, France. Charles-Edouard Luyt: Service de Médecine Intensive Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 47-83, Boulevard de l'Hôpital, 75651, Paris Cedex 13, France. Benjamin Kowalski: Service de réanimation et de soins intensifs, centre hospitalier de Douai, route de Cambrai, Douai, France. Edgar Moglia: Critical Care Department, Hospital Universitari Parc Taulí, Sabadell, Spain. Luis Morales: Intensive Care Unit, Hospital Universitari Sagrat Cor, and Universidad Autonoma de Barcelona, Barcelona, Spain Intensive Care Unit, Hospital Unive rsitari Sagrat Cor, Barcelona, Spain; Institut d'Investigacio i Innovacio Parc Tauli, Sabadell, Spain. Antonia Koutsoukou: 1st Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, "Sotiria" Chest Hospital, Athens, Greece. Spyros D. Mentzelopoulos: 1st Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos Hospital, Athens, Greece. David Nora: Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal. Sean Boyd: 3Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, St. James Street, Dublin 8, Dublin, Eire, Ireland. Julien Maizel: Medical ICU, Amiens university hospital, Amiens, France. Pierre Cuchet: Department of Medical Intensive Care, Caen University Hospital, F-14000 Caen, France. Quentin Delforge: Service de Médecine Intensive Réanimation, Centre hospitalier de Béthune. Jean-Pierre Quenot: Department of Intensive Care, François Mitterrand University Hospital, Dijon, France. Déborah Boyer: 42Medical Intensive Care Unit, Rouen University Hospital, Rouen, France. Catia Cilloniz: Pulmonology Department, Hospital Clinic of Barcelona, Ciber de Enfermedades Respiratorias (Ciberes, CB06/06/0028)-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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