PREDICTORS FOR INPATIENT MORTALITY AMONG HOSPITALIZATIONS WITH VENTILATOR-ASSOCIATED PNEUMONIA: NATIONAL INPATIENT DATABASE 2016-2017

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Ventilator-associated pneumonia (VAP) is a major cause of healthcare-associated mortality and morbidity in critically ill patients who are mechanically ventilated. The purpose of this study is to describe the various primary discharge diagnoses of hospitalizations with ventilator-associated pneumonia, to identify their demographic characteristics, and to identify risk factors for mortality in hospitalizations with ventilator-associated pneumonia. METHODS: Hospitalizations with a diagnosis of ventilator-associated pneumonia who were mechanically ventilated for over twenty-four hours were selected from the National Inpatient Sample in 2016 and 2017. The top fifteen principal diagnoses and their proportions among hospitalizations with VAP were identified. Independent predictors for inpatient mortality among hospitalizations with ventilator associated pneumonia were identified. Confounders were adjusted for using multivariate regression analysis. RESULTS: In total, 33,140 hospitalizations with VAP were analyzed. The leading primary discharge diagnoses for hospitalizations leading to VAP were sepsis due to unspecified organism (16.92%), respiratory failure (8.09%), and VAP (6.38%). Mortality among hospitalizations with ventilator associated pneumonia was 20.9%. Independent risk factors for mortality in hospitalizations with VAP were uninsured status (aOR 2.13, 95% CI 1.49 – 3.06, p<0.001), acute renal failure (aOR 2.00, 95% CI 1.75 – 2.30, p<0.001), and liver disease (aOR 1.82, 95% CI 1.52 – 2.18, p<0.001). CONCLUSIONS: Ventilator-associated pneumonia is associated with significant mortality. Infective, traumatic, cardiovascular, and respiratory conditions accounted for over 85% of hospitalizations with VAP. Acute renal failure, the presence of liver disease, and lack of insurance are associated with greater mortality in hospitalizations with ventilator associated pneumonia. CLINICAL IMPLICATIONS: Ventilator-associated pneumonia (VAP) is recognized as a major cause of healthcare-associated morbidity and mortality in critically ill patients and is secondary to impaired muco-ciliary clearance of the airways in mechanically ventilated patients and micro-aspirations around the endotracheal tube cuff. Although there is literature discussing the pathophysiology and healthcare burden of VAP, there is a need for objective data focusing on in-hospital mortality in patients diagnosed with VAP. This retrospective cohort study was designed to address this paucity in the literature. We aimed to establish and investigate associations between numerous conditions and in-hospital mortality in patients with VAP. In this study, we found that the presence of liver disease, acute renal failure or uninsured status were associated with a greater likelihood of mortality in hospitalizations with ventilator associated pneumonia. Thus, we strongly believe that those hospitalized with VAP and liver disease, acute renal failure, or uninsured status may be at higher risk of death and should be monitored appropriately but aggressively. Ultimately, ventilator-associated pneumonia is associated with significant mortality and morbidity and any critically ill patient may potentially at risk of developing ventilator associated pneumonia; therefore, understanding associated mortality risks is an important measure in improving survival in hospitalized patients. DISCLOSURES: No relevant relationships by Zain El-amir, source=Web Response No relevant relationships by Asim Kichloo, source=Web Response No relevant relationships by Hafeez Shaka, source=Web Response No relevant relationships by Farah Wani, source=Web Response No relevant relationships by Timothy Schwarz, source=Web Response