Attributable Mortality of Ventilator-associated Pneumonia. Replicating Findings, Revisiting Methods

Rationale: Estimating the impact of ventilator-associated pneumonia (VAP) from routinely collected intensive care unit (ICU) data is methodologically challenging.Objectives: We aim to replicate earlier findings of limited VAP-attributable ICU mortality in an independent cohort. By refining statistical analyses, we gradually tackle different sources of bias.Methods: Records of 2,720 adult patients admitted to Ghent University Hospital ICUs (2013-2017) and receiving mechanical ventilation within 48 hours after admission were extracted from linked Intensive Care Information System and Computer-based Surveillance and Alerting of Nosocomial Infections, Antimicrobial Resistance, and Antibiotic Consumption in the ICU databases. The VAP-attributable fraction of ICU mortality was estimated using a competing risk analysis that is restricted to VAP-free patients (approach 1), accounts for VAP onset by treating it as either a competing (approach 2) or censoring event (approach 3), or additionally adjusts for time-dependent confounding via inverse probability weighting (approach 4).Results: A total of 210 patients (7.7%) acquired VAP. Based on benchmark approach 4, we estimated that (compared with current preventive measures) hypothetical eradication of VAP would lead to a relative ICU mortality reduction of 1.7% (95% confidence interval, -1.3 to 4.6) by Day 10 and of 3.6% (95% confidence interval, 0.7 to 6.5) by Day 60. Approaches 1-3 produced estimates ranging from -0.7% to 2.5% by Day 10 and from 5.2% to 5.5% by Day 60.Conclusions: In line with previous studies using appropriate methodology, we found limited VAP-attributable ICU mortality given current state-of-the-art VAP prevention measures. Our study illustrates that inappropriate accounting of the time dependency of exposure and confounding of its effects may misleadingly suggest protective effects of early-onset VAP and systematically overestimate attributable mortality.

Errataetall:

CommentIn: Ann Am Thorac Soc. 2021 May;18(5):777-779. - PMID 33929311

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:18

Enthalten in:

Annals of the American Thoracic Society - 18(2021), 5 vom: 15. Mai, Seite 830-837

Sprache:

Englisch

Beteiligte Personen:

Steen, Johan [VerfasserIn]
Vansteelandt, Stijn [VerfasserIn]
De Bus, Liesbet [VerfasserIn]
Depuydt, Pieter [VerfasserIn]
Gadeyne, Bram [VerfasserIn]
Benoit, Dominique D [VerfasserIn]
Decruyenaere, Johan [VerfasserIn]

Links:

Volltext

Themen:

Causality
Confounding factors (epidemiology)
Hospital mortality
Journal Article
Survival analysis
Ventilator-associated pneumonia

Anmerkungen:

Date Completed 18.08.2021

Date Revised 18.08.2021

published: Print

CommentIn: Ann Am Thorac Soc. 2021 May;18(5):777-779. - PMID 33929311

Citation Status MEDLINE

doi:

10.1513/AnnalsATS.202004-385OC

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM318508966