Abstract
BackgroundMechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients.MethodsTotally, 8182 patients who aged ≥18 years and received mechanical ventilation (MV) in ICU from Medical Information Mart for Intensive Care III (MIMIC III) database were involved in this study. All subjects were divided into the VAP group (n = 537) and the non-VAP group (n = 7626) based on the occurrence of VAP. Clinical data of all participants were collected. The effect of VAP on the prognosis of ICU patients was explored by binary logistic regression analysis.ResultsThe results delineated that the 90-day mortality of VAP patients in ICU was 33.33% and 180-day mortality was 37.62%. The 90-day and 180-day mortality rates were higher in the VAP group than in the non-VAP group. After adjusting the confounders including age, ethnicity, heart failure, septicemia, simplified acute physiology score II (SAPSII) score, sequential organ failure assessment (SOFA) score, serum lactate, white blood cell (WBC), length of ICU stay, length of hospital stay, length of ventilation, antibiotic treatment, Pseudomonas aeruginosa (P.aeruginosa), methicillin-resistant Staphylococcus aureus (MRSA), other pathogens, the risk of 90-day and 180-day mortalities in VAP patients were 1.465 times (OR = 1.465, 95%CI: 1.188–1.807, P < 0.001) and 1.635 times (OR = 1.635, 95%CI: 1.333–2.005, P < 0.001) higher than those in non-VAP patients, respectively.ConclusionsOur study revealed that ICU patients with VAP had poorer prognosis than those without VAP. The results of this study might offer a deeper insight into preventing the occurrence of VAP.
Highlights
Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen
Comparison of characteristics between ventilator-associated pneumonia (VAP) group and non-VAP group After comparing the clinical characteristics of ICU patients in the VAP group and non-VAP group, we found that the age of patients in the VAP group was younger than the non-VAP group (62.29 years vs 64.19 years, t = 2.260, P = 0.009), and the proportions of heart failure (32.03% vs 25.37%, χ2 = 11.607, P < 0.001), septicemia (31.47% vs 17.36%, χ2 = 66.828, P < 0.001), antibiotic treatment (Z = 18.883, P < 0.001), P. eruginosa (P < 0.001), methicillin-resistant Staphylococcus aureus (MRSA) (4.66% vs 2.05%, χ2 = 15.760, P < 0.001) and other pathogens (14.90% vs 9.05%, χ2 = 20.094, P < 0.001) were in the VAP group were higher than non-VAP group
The simplified acute physiology score II (SAPSII) score (41.00 vs 38.00, Z = 3.679, P < 0.001), sequential organ failure assessment (SOFA) score (7.581 vs 7.096, t = − 3.040, P = 0.002), serum lactate (1.80 mmol/L vs 1.60 mmol/L, Z = 2.773, P = 0.006), white blood cell (WBC) (12.00 109/L vs 11.50 109/L, Z = 2.068, P = 0.039) in the VAP group were higher than the nonVAP group
Summary
Mechanical ventilation (MV) is often applied in critically ill patients in intensive care unit (ICU) to protect the airway from aspiration, and supplement more oxygen. MV may result in ventilator-associated pneumonia (VAP) in ICU patients. This study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients. Ventilator-associated pneumonia (VAP) is a common nosocomial infection in ICU occurring > 48 h after endotracheal intubation in patients receiving MV [3]. VAP in ICU has an incidence of 13.5 to 23%, and accounts for one of the common causes of morbidity and mortality [12, 13]. The aim of this study was to estimate the 90-day and 180-day mortalities of ICU patients with VAP, and to explore the influence of VAP on the outcomes of ICU patients.
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