Influenza and associated co-infections in critically ill immunosuppressed patients

Show simple item record Martin-Loeches, Ignacio Lemiale, Virginie Geoghegan, Pierce McMahon, Mary A Pickkers, Peter Soares, Marcio Perner, Anders Meyhoff, Tine S Bukan, Ramin B Rello, Jordi Bauer, Philippe R van de Louw, Andry Taccone, Fabio S Salluh, Jorge Hemelaar, Pleun Schellongowski, Peter Rusinova, Katerina Terzi, Nicolas Mehta, Sangeeta Antonelli, Massimo Kouatchet, Achille Klepstad, Pål Valkonen, Miia Landburg, Precious P Barratt-Due, Andreas Bruneel, Fabrice Pène, Frédéric Metaxa, Victoria Moreau, Anne S Souppart, Virginie Burghi, Gaston Girault, Christophe Silva, Ulysses V A Montini, Luca Barbier, Francois Nielsen, Lene B Gaborit, Benjamin Mokart, Djamel Chevret, Sylvie Azoulay, Elie 2019-05-05T03:36:50Z 2019-05-05T03:36:50Z 2019-05-02
dc.identifier.citation Critical Care. 2019 May 02;23(1):152
dc.description.abstract Abstract Background It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90–1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.
dc.publisher BioMed Central
dc.subject Influenza
dc.subject Respiratory failure
dc.subject Sepsis
dc.subject Critical illness
dc.subject Immunosuppression
dc.title Influenza and associated co-infections in critically ill immunosuppressed patients 2019-05-05T03:36:50Z
dc.language.rfc3066 en
dc.rights.holder The Author(s).

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