Attributable mortality of ventilator-associated pneumonia

A meta-analysis of individual patient data from randomised prevention studies

Wilhelmina G. Melsen, Maroeska M. Rovers, Rolf H.H. Groenwold, Dennis C.J.J. Bergmans, Christophe Camus, Torsten T. Bauer, Ernst W. Hanisch, Bengt Klarin, Mirelle Koeman, Wolfgang A. Krueger, Jean Claude Lacherade, Leonardo Lorente, Ziad A. Memish, Lee E. Morrow, Giuseppe Nardi, Christianne A. van Nieuwenhoven, Grant E. O'Keefe, George Nakos, Frank A. Scannapieco, Philippe Seguin & 4 others Thomas Staudinger, Arzu Topeli, Miquel Ferrer, Marc J.M. Bonten

Research output: Contribution to journalArticle

285 Citations (Scopus)

Abstract

Background: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods: We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings: Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1·13 (95% CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·91-2·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2·97, 95% CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS 2 scores of 35-58). Interpretation: The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay. Funding: None.

Original languageEnglish (US)
Pages (from-to)665-671
Number of pages7
JournalThe Lancet Infectious Diseases
Volume13
Issue number8
DOIs
StatePublished - Aug 1 2013
Externally publishedYes

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Ventilator-Associated Pneumonia
Meta-Analysis
Mortality
Intensive Care Units
APACHE
Wounds and Injuries
Risk Reduction Behavior

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Cite this

Melsen, W. G., Rovers, M. M., Groenwold, R. H. H., Bergmans, D. C. J. J., Camus, C., Bauer, T. T., ... Bonten, M. J. M. (2013). Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies. The Lancet Infectious Diseases, 13(8), 665-671. https://doi.org/10.1016/S1473-3099(13)70081-1

Attributable mortality of ventilator-associated pneumonia : A meta-analysis of individual patient data from randomised prevention studies. / Melsen, Wilhelmina G.; Rovers, Maroeska M.; Groenwold, Rolf H.H.; Bergmans, Dennis C.J.J.; Camus, Christophe; Bauer, Torsten T.; Hanisch, Ernst W.; Klarin, Bengt; Koeman, Mirelle; Krueger, Wolfgang A.; Lacherade, Jean Claude; Lorente, Leonardo; Memish, Ziad A.; Morrow, Lee E.; Nardi, Giuseppe; van Nieuwenhoven, Christianne A.; O'Keefe, Grant E.; Nakos, George; Scannapieco, Frank A.; Seguin, Philippe; Staudinger, Thomas; Topeli, Arzu; Ferrer, Miquel; Bonten, Marc J.M.

In: The Lancet Infectious Diseases, Vol. 13, No. 8, 01.08.2013, p. 665-671.

Research output: Contribution to journalArticle

Melsen, WG, Rovers, MM, Groenwold, RHH, Bergmans, DCJJ, Camus, C, Bauer, TT, Hanisch, EW, Klarin, B, Koeman, M, Krueger, WA, Lacherade, JC, Lorente, L, Memish, ZA, Morrow, LE, Nardi, G, van Nieuwenhoven, CA, O'Keefe, GE, Nakos, G, Scannapieco, FA, Seguin, P, Staudinger, T, Topeli, A, Ferrer, M & Bonten, MJM 2013, 'Attributable mortality of ventilator-associated pneumonia: A meta-analysis of individual patient data from randomised prevention studies', The Lancet Infectious Diseases, vol. 13, no. 8, pp. 665-671. https://doi.org/10.1016/S1473-3099(13)70081-1
Melsen, Wilhelmina G. ; Rovers, Maroeska M. ; Groenwold, Rolf H.H. ; Bergmans, Dennis C.J.J. ; Camus, Christophe ; Bauer, Torsten T. ; Hanisch, Ernst W. ; Klarin, Bengt ; Koeman, Mirelle ; Krueger, Wolfgang A. ; Lacherade, Jean Claude ; Lorente, Leonardo ; Memish, Ziad A. ; Morrow, Lee E. ; Nardi, Giuseppe ; van Nieuwenhoven, Christianne A. ; O'Keefe, Grant E. ; Nakos, George ; Scannapieco, Frank A. ; Seguin, Philippe ; Staudinger, Thomas ; Topeli, Arzu ; Ferrer, Miquel ; Bonten, Marc J.M. / Attributable mortality of ventilator-associated pneumonia : A meta-analysis of individual patient data from randomised prevention studies. In: The Lancet Infectious Diseases. 2013 ; Vol. 13, No. 8. pp. 665-671.
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abstract = "Background: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods: We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings: Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13{\%}, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1·13 (95{\%} CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·91-2·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2·97, 95{\%} CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS 2 scores of 35-58). Interpretation: The overall attributable mortality of ventilator-associated pneumonia is 13{\%}, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay. Funding: None.",
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TY - JOUR

T1 - Attributable mortality of ventilator-associated pneumonia

T2 - A meta-analysis of individual patient data from randomised prevention studies

AU - Melsen, Wilhelmina G.

AU - Rovers, Maroeska M.

AU - Groenwold, Rolf H.H.

AU - Bergmans, Dennis C.J.J.

AU - Camus, Christophe

AU - Bauer, Torsten T.

AU - Hanisch, Ernst W.

AU - Klarin, Bengt

AU - Koeman, Mirelle

AU - Krueger, Wolfgang A.

AU - Lacherade, Jean Claude

AU - Lorente, Leonardo

AU - Memish, Ziad A.

AU - Morrow, Lee E.

AU - Nardi, Giuseppe

AU - van Nieuwenhoven, Christianne A.

AU - O'Keefe, Grant E.

AU - Nakos, George

AU - Scannapieco, Frank A.

AU - Seguin, Philippe

AU - Staudinger, Thomas

AU - Topeli, Arzu

AU - Ferrer, Miquel

AU - Bonten, Marc J.M.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Background: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods: We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings: Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1·13 (95% CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·91-2·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2·97, 95% CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS 2 scores of 35-58). Interpretation: The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay. Funding: None.

AB - Background: Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention. Methods: We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores. Findings: Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1·13 (95% CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·91-2·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2·97, 95% CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS 2 scores of 35-58). Interpretation: The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay. Funding: None.

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