In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany

Abstract Introduction The effect of valve type on outcomes in transfemoral transcatheter aortic valve replacement (TF-TAVR) has recently been subject of debate. We investigate outcomes of patients treated with balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of all these procedures performed in Germany in 2018. Methods All patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413) valves in Germany in 2018 were identified. In-hospital outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, permanent pacemaker implantation, mechanical ventilation > 48 h, length of hospital stay, and reimbursement. Since patients were not randomized to the two treatment options, logistic or linear regression models were used with 22 baseline patient characteristics and center-specific variables as potential confounders. As a sensitivity analysis, the same confounding factors were taken into account using the propensity score methods (inverse probability of treatment weighting). Results Baseline characteristics differed substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate of female sex (p < 0.001) in SE treated patients. After risk adjustment, no marked differences in outcomes were found for in-hospital mortality [risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI 0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400], stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97 (0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p = 0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893], length of hospital stay (risk adjusted difference in days of hospitalization (SE instead of BE): − 0.05 [− 0.34;0.25], p = 0.762) and reimbursement [risk adjusted difference in reimbursement (SE instead of BE): − €72 (− €291;€147), p = 0.519)] There is, however, an increased risk of PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were found after application of propensity score adjustment. Conclusions We find broadly equivalent outcomes in contemporary TF-TAVR procedures, regardless of the valve type used. Incidence of major complications is very low for both types of valve.

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Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1247 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Shetty ◽

H Malik ◽

A Abbas ◽

Y Ying ◽

W Aronow ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Kidney Injury ◽

Matched Cohort ◽

Hospital Outcomes ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

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Prevalence of acute kidney injury in myeloma patients visiting U.S. emergency departments: A nationwide analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20548 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20548-e20548

Author(s):

Umar Zahid ◽

Preethi Ramachandran ◽

Lutfi Alasadi ◽

Puneet Bedi ◽

Sergiy Shurin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Admission ◽

Hospital Stay ◽

Emergency Departments ◽

Multivariable Analysis ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

National Study ◽

Urban Residents

e20548 Background: Patients diagnosed with multiple myeloma (MM) frequently visit emergency departments (ED) with complications, commonly with kidney disease. However, data regarding the prevalence of acute kidney injury (AKI) and its effects on patient outcome, economic burden, length of hospital stay and mortality among these patients are lacking. Methods: From the Nationwide Emergency Department Sample, we obtained 7-year (2010-2016) data of myeloma patients who visited ED. Baseline characteristics of these patients with and without AKI were compared. The multivariable regression model was used to estimate hospital admission, length of stay, healthcare burden and in-hospital mortality in patients with and without AKI. Results: Between 2010-2016, 657,392 adult myeloma patients visited ED at an increased rate from 35 to 45 per 100,000 census population. The prevalence of AKI was 22.5% (n = 147,743) with a stable trend over the study period. AKI was more common in patients with relapsed MM (33.5%) than those in remission (18.6%) or never achieving remission (22.4%) (P < 0.001), male (24.1 vs 20.6% in female, P < 0.001), age ≥65 years (24.1%) vs 18-44 years (12.9%), or 45-64 years (19.3%)(P < 0.001) and urban (23.3%) vs non-urban residents (17.9%)(P < 0.001). The majority patients with AKI were hospitalized (96.5%) compared with those without AKI (69.6%) (P < 0.001). In multivariable analysis, odds of hospitalization was higher in patients with AKI (OR: 8.8, P < 0.001) after adjusting age, gender, co-morbidities and other demographics. Median hospital stay was longer in patients with AKI compared to those without (6 vs 4 days, P < 0.001). Median ED and total hospitalization charges were higher in patients with AKI (ED: $2,057; total: $45,414) vs without AKI (ED: $1,853; total: $29,299) (P < 0.001). In the multivariable adjusted-model, odds of in-hospital mortality was significantly higher in patients not in remission (OR: 1.8), patients with relapse (OR: 2.3), AKI (OR: 2.2), age ≥ 65 years (OR: 1.4), male (OR: 1.1) and urban residents (OR:1.2). Conclusions: In this largest national study of MM patients visiting ED, patients with AKI had higher in-hospital admission, ED and total charges, length of hospital stays, and mortality, both by univariate and multivariate analysis. Prevalence of AKI and mortality were highest in patients with MM relapse.

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Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study

Scientific Reports ◽

10.1038/s41598-021-94946-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Abinet Abebe ◽

Kabaye Kumela ◽

Maekel Belay ◽

Bezie Kebede ◽

Yohannes Wobie

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Low Income ◽

Statistical Significance ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Public Health Problem ◽

Medical Ward ◽

High Rate

AbstractAcute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17–28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37–36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05–0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12–11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.

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Mortality and Predictors of Acute Kidney Injury in Adults: A Hospital-Based Prospective Observational Study

10.21203/rs.3.pex-1585/v1 ◽

2021 ◽

Author(s):

Abinet Abebe ◽

Kabaye Kumela ◽

Maekel Belay ◽

Bezie Kebede ◽

Yohannes Wobie

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Low Income ◽

Statistical Significance ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Public Health Problem ◽

Medical Ward ◽

High Rate

Abstract Background: Acute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward.Methods: We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 hours were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05.Result: A total of 203 patients were enrolled over five months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage3 AKI (AHR=9.61, 95% CI: 1.17-28.52, p=0.035), duration of AKI (AHR =7.04, 95% CI: 1.37-36.08, p=0.019), length of hospital stay (AHR= 0.19, 95% CI: 0.05-0.73 p=0.012), and hyperkalemia (AHR =3.61, 95% CI: 1.12-11.71, p=0.032) were significantly associated with in-hospital mortality.Conclusion: There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-day in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.

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Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/20543581211027759 ◽

2021 ◽

Vol 8 ◽

pp. 205435812110277

Author(s):

Tyler Pitre ◽

Angela (Hong Tian) Dong ◽

Aaron Jones ◽

Jessica Kapralik ◽

Sonya Cui ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Disease Severity ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Kidney Injury ◽

Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

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Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽

10.1177/02676591211049767 ◽

2021 ◽

pp. 026765912110497

Author(s):

Christopher Gaisendrees ◽

Borko Ivanov ◽

Stephen Gerfer ◽

Anton Sabashnikov ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Acute Kidney Injury ◽

Creatine Kinase ◽

High Risk ◽

Cardiopulmonary Resuscitation ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Dialysis Patients ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

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P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis

European Heart Journal ◽

10.1093/eurheartj/ehz746.0454 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Seguchi ◽

K Sakakura ◽

K Yamamoto ◽

Y Taniguchi ◽

H Wada ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Propensity Score ◽

Hospital Stay ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Length Of Hospital Stay ◽

Hospital Death ◽

Very Elderly ◽

Hospital Outcomes

Abstract Background Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians. Methods We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38). Results Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01). Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase. Flow-chart Conclusions The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed. Acknowledgement/Funding None

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High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-014171 ◽

2017 ◽

Vol 7 (10) ◽

pp. e014171 ◽

Cited By ~ 7

Author(s):

Peng Li ◽

Li-ping Qu ◽

Dong Qi ◽

Bo Shen ◽

Yi-mei Wang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Meta Analysis ◽

Kidney Injury ◽

High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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Efficacy of probiotics in the prevention of VAP in critically ill ICU patients: an updated systematic review and meta-analysis of randomized control trials

Journal of Intensive Care ◽

10.1186/s40560-020-00487-8 ◽

2020 ◽

Vol 8 (1) ◽

Author(s):

Priyam Batra ◽

Kapil Dev Soni ◽

Purva Mathur

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Icu Stay ◽

Length Of Icu Stay

Abstract Introduction Ventilator-associated pneumonia (VAP) is reported as the second most common nosocomial infection among critically ill patients with the incidence ranging from 2 to 16 episodes per 1000 ventilator days. The use of probiotics has been shown to have a promising effect in many RCTs. Our systematic review and meta-analysis were thus planned to determine the effect of probiotic use in critically ill ventilated adult patients on the incidence of VAP, length of hospital stay, length of ICU stay, duration of mechanical ventilation, the incidence of diarrhea, and the incidence of oropharyngeal colonization and in-hospital mortality. Methodology Systematic search of various databases (such as Embase, Cochrane, and Pubmed), published journals, clinical trials, and abstracts of the various major conferences were made to obtain the RCTs which compare probiotics with placebo for VAP prevention. The results were expressed as risk ratios or mean differences. Data synthesis was done using statistical software - Review Manager (RevMan) Version 5.4 (The Cochrane Collaboration, 2020). Results Nine studies met our inclusion criterion and were included in the meta-analysis. The incidence of VAP (risk ratio: 0.70, CI 0.56, 0.88; P = 0.002; I2 = 37%), duration of mechanical ventilation (mean difference −3.75, CI −6.93, −0.58; P 0.02; I2 = 96%), length of ICU stay (mean difference −4.20, CI −6.73, −1.66; P = 0.001; I2 = 84%) and in-hospital mortality (OR 0.73, CI 0.54, 0.98; P = 0.04; I2 = 0%) in the probiotic group was significantly lower than that in the control group. Probiotic administration was not associated with a statistically significant reduction in length of hospital stay (MD −1.94, CI −7.17, 3.28; P = 0.47; I2 = 88%), incidence of oro-pharyngeal colonization (OR 0.59, CI 0.33, 1.04; P = 0.07; I2 = 69%), and incidence of diarrhea (OR 0.59, CI 0.34, 1.03; P = 0.06; I2 = 38%). Discussion Our meta-analysis shows that probiotic administration has a promising role in lowering the incidence of VAP, the duration of mechanical ventilation, length of ICU stay, and in-hospital mortality.

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