Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

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 group (adjusted HR 1.65 (95% CI 1.11-2.46), p = 0.013), but not in influenza (1.74 (0.99-3.06), p = 0.052), or no viral infection groups (1.13 (0.68-1.86), p = 0.63). 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

a retrospective multicenter study

Funding 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). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or deci sion to submit for publication.BACKGROUND: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. RESULTS: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. CONCLUSIONS: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.publishersversionpublishe

a planned ancillary analysis of the coVAPid cohort

Funding: 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 interpreta tion, writing of the report, or decision to submit for publication.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.publishersversionpublishe

Valeur Pronostic [i.e. pronostique] du statut antioxydant en préopératoire d'une chirurgie cardiaque à coeur battant

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Statut antioxydant et inflammatoire du patient septique à l'admission en réanimation (corrélation bioclinique et valeur pronostique)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

EVALUATION DU TAUX SERIQUE DE LA PROCALCITONINE POUR LE DIAGNOSTIC DES PNEUMOPATHIES NOSOCOMIALES EN REANIMATION

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation bio-clinique et valeur pronostique du MR-proADM à la phase aiguë du choc septique

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Evaluation du taux de carnitine plasmatique à l'admission en réanimation de l'insuffisant respiratoire chronique (IRC) en décomposition aiguë

Objectif: Evaluer le taux de la carnitine et de ses dérivés à l admission en réanimation des patients ayant une IRC en décompensation aiguë, et rechercher un lien éventuel entre les valeurs initiales de carnitine, l état nutritionnel, le SAO et la morbi-mortalité. Patients et méthodes: étude prospective, monocentrique, menée sur 22 mois. Tous les patients admis en réanimation pour décompensation aiguë d IRC nécessitant une intubation trachéale pour ventilation mécanique étaient inclus. Le dosage des valeurs de carnitine était réalisé à l entrée du patient en réanimation. Etaient aussi évalués: le statut nutritionnel, le statut antioxydant total. La morbidité était appréciée par la survenue d une pneumonie acquise sous ventilation mécanique, la durée de ventilation, la durée de séjour en réanimation. Tous les patients bénéficiaient d une nutrition artificielle précoce. Les tests de Mann et Witney, de Spearman et du 2 ont été utilisés pour l analyse statistique. Résultats: 29 patients sont inclus. L âge est de 69 +- 10.8 [73] ans, l albuminémie de 26.7 +- 5.5 [26.2] g/l, la préalbuminémie de 0.12 +- 0.04 [0.12] g/l. La carnitine totale est de 69.9 +- 27.3 [64] mol/l, la carnitine libre de 42.6 +- 20 [36.8] mol/l, la carnitine estérifiée de 27.3 +- 9.7 [24.4] mol/l, et le rapport carnitine estérifiée sur libre de 0.70 +- 0.26 [0.63]. Il y a une corrélation positive entre la carnitine totale et estérifiée et la sélénémie (p<0,05). L incidence des PNAVM est de 27%, la mortalité hospitalière est de 46,6%. Les taux de carnitine mesurés n ont pas de lien statistique avec la DVI, la DSR et la mortalité en réanimation. Conclusion: 90% des patients IRC inclus dans notre travail présentent un déficit en carnitine. Les valeurs initiale de carnitine sont corrélées à la sélénémie Nous ne retrouvons pas de lien satistiquement significatif a été mis en évidence entre les valeurs initiale de carnitine, l état nutritionnel le SAO et la morbi-mortalité.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Statuts nutritionnel et anti-oxydant du patient insuffisant respiratoire chronique à l'admission en réanimation pour décompensation aiguë

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Fatality associated with propylene glycol poisoning in a cirrhotic patient

International audienc