Epidemiological Study and Analysis of Risk Factors for Elizabethkingia Meningoseptica Infection in a Large General Hospital in China

Abstract Background As a kind of nosocomial infection pathogen which can cause high mortality, its susceptibility and death risk factors are still unclear. Aim To analyze the epidemiological characteristics of and risk factors for Elizabethkingia meningoseptica infection. Methods Relevant literature from 2011 to 2019 with the key words “E. meningoseptica” or “Elizabethkingia meningoseptica” in the title and abstract was retrieved from the PubMed database. The risk factors of infection and death for infected patients treated at Southwest Hospital during the above period were analyzed by logistic regression. Results From 2011 to 2019, 366 patients infected with E. meningoseptica were reported in 132 articles in the PubMed database. The mortality rate was 63.20%. During the same period, 92 infected patients were treated at our hospital. The overall mortality rate was approximately 28.3% (26/92) to 39.1% (36/92). The resistance rate for carbapenems was 100%; for cephalosporins, it was more than 90%; and for minocycline, it was 0. Central venous catheterization (p < 0.001), mechanical ventilation (p = 0.015), bacteria type (p < 0.001), operation type (p = 0.001), fungal infection (p < 0.001), carbapenem use (p = 0.000), and triazole use (p = 0.016) were independent risk factors for E. meningoseptica infection. According to logistic regression, bacteria type (p = 0.037), platelet level (p = 0.014), and mechanical ventilation (p = 0.043) were risk factors for death. Conclusion The incidence of E. meningoseptica infection worldwide shows a trend toward increasing yearly. Invasive operations, multiple bacterial or fungal infections and the use of carbapenems may be predisposing factors, and platelet level, bacteria type, and mechanical ventilation were risk factors for death.

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Risk factors for mortality and mortality rates in interstitial lung disease patients in the intensive care unit

European Respiratory Review ◽

10.1183/16000617.0061-2018 ◽

2018 ◽

Vol 27 (150) ◽

pp. 180061 ◽

Cited By ~ 5

Author(s):

Julio A. Huapaya ◽

Erin M. Wilfong ◽

Christopher T. Harden ◽

Roy G. Brower ◽

Sonye K. Danoff

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Interstitial Lung Disease ◽

Mortality Rate ◽

Lung Disease ◽

Mortality Rates ◽

Population Heterogeneity

Data on interstitial lung disease (ILD) outcomes in the intensive care unit (ICU) is of limited value due to population heterogeneity. The aim of this study was to examine risk factors for mortality and ILD mortality rates in the ICU.We performed a systematic review using five databases. 50 studies were identified and 34 were included: 17 studies on various aetiologies of ILD (mixed-ILD) and 17 on idiopathic pulmonary fibrosis (IPF). In mixed-ILD, elevated APACHE score, hypoxaemia and mechanical ventilation are risk factors for mortality. No increased mortality was found with steroid use. Evidence is inconclusive on advanced age. In IPF, evidence is inconclusive for all factors except mechanical ventilation and hypoxaemia. The overall in-hospital mortality was available in 15 studies on mixed-ILD (62% in 2001–2009 and 48% in 2010–2017) and 15 studies on IPF (79% in 1993–2004 and 65% in 2005–2017). Follow-up mortality rate at 1 year ranged between 53% and 100%.Irrespective of ILD aetiology, mechanical ventilation is associated with increased mortality. For mixed-ILD, hypoxaemia and APACHE scores are also associated with increased mortality. IPF has the highest mortality rate among ILDs, but since 1993 the rate appears to be declining. Despite improving in-hospital survival, overall mortality remains high.

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Late Acute Kidney Injury is a Poor Prognosis Sign in Severe Burns: A Retrospective Cohort Study

10.21203/rs.3.rs-111856/v1 ◽

2020 ◽

Author(s):

Bo You ◽

Zi Chen Yang ◽

Yu Long Zhang ◽

Yu Chen ◽

Yun Long Shi ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Poor Prognosis ◽

Multiple Logistic Regression Analysis ◽

Kidney Injury ◽

Occurrence Rate ◽

Severe Burns ◽

Epidemiological Characteristics

Abstract BackgroundAcute kidney injury (AKI) is a morbid complication and the main cause of multiple organ failure and death in severely burned patients. The objective of this study was to explore the epidemiological characteristics, the risk factors, and impact of both early and late AKIs, respectively.MethodsThis retrospective study was performed with prospectively collected data of severely burned patients from the Institute of Burn Research in Southwest Hospital during 2011-2017. AKI was diagnosed according to Kidney Disease Improving Global Outcomes (KDIGO) criteria (2012), and it was divided into early and late AKIs depending on its onset time (within the first 3 days or >3 days post burn). The baseline characteristics, clinical data, and outcomes of the three groups (early AKI, late AKI and non-AKI) were compared using logistic regression analysis. Mortality predictors of patients with AKI were assessed.ResultsA total of 637 patients were included in analysis. The incidence of AKI was 36.9% (early AKI 29.4%, late AKI 10.0%). The mortality of patients with AKI was 32.3% (early AKI 25.7%, late AKI 56.3%), and that of patients without AKI was 2.5%. AKI was independently associated with obviously increased mortality of severely burned patients [early AKI, OR = 12.98 (6.08-27.72); late AKI, OR = 34.02 (15.69-73.75)]. Multiple logistic regression analysis revealed that age, gender, total burn surface area (TBSA), full-thickness burns of TBSA, chronic comorbidities (hypertension or/and diabetes), hypovolemic shock of early burn, and tracheotomy were independent risk factors for both early and late AKIs. However, sepsis was only a risk factor for late AKI. Decompression escharotomy was a protective factor for both AKIs. ConclusionsAKI remains prevalent and is associated with high mortality in severely burned patients. Compared with early AKI, late AKI has a lower occurrence rate, but greater severity and worse prognosis，is a devastating complication. Late AKI is a poor prognosis sign in severe burns.

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Nakata index above 1500 mm2/m2 predicts death in absent pulmonary valve syndrome

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz167 ◽

2019 ◽

Vol 57 (1) ◽

pp. 46-53

Author(s):

Yasemin Karaca-Altintas ◽

Daniela Laux ◽

Marielle Gouton ◽

Myriam Bensemlali ◽

Régine Roussin ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Risk Factor ◽

Mortality Rate ◽

Pulmonary Valve ◽

Prolonged Mechanical Ventilation ◽

Absent Pulmonary Valve ◽

Lower Weight ◽

Prolonged Ventilation ◽

Absent Pulmonary Valve Syndrome

AbstractOBJECTIVESAbsent pulmonary valve syndrome is a rare congenital heart disease with severe airway compression due to dilatation of the pulmonary arteries (PAs). We investigated risk factors for death and prolonged mechanical ventilation (>7 days) and a threshold PA size for these outcomes.METHODSThis retrospective 2-centre cohort study included 68 patients with complete repair between January 1996 and December 2015.RESULTSMedian age at repair was 3.9 months (1.3–8.7 months), and median weight was 5 kg (4–7 kg). The mortality rate before hospital discharge was 12%, and the mortality rate at last follow-up was 19%. In multivariable analysis, risk factors for death were higher Nakata index [hazard ratio (HR) 1.001, 95% confidence interval (CI) 1.001–1.002; P < 0.001] and lower SpO2 (HR 1.06, 95% CI 1.02–1.09; P = 0.002). The accuracy of the Nakata index to predict death was excellent (area under the curve at 6 months: 0.92; P = 0.010). A Nakata index above 1500 mm2/m2 predicted mortality at 6 months with a sensitivity of 98% and a specificity of 82%. Twenty-five patients (37%) had prolonged mechanical ventilation. The only multivariable risk factor for prolonged ventilation was lower weight at repair (odds ratio 2.9, 95% CI 1.3–6.7; P = 0.008). Neither PA plasty nor the LeCompte manoeuvre had a protective effect on mortality or prolonged ventilation. A Nakata index above 1500 mm2/m2 remained a risk factor for mortality (P = 0.022) in patients who had a PA plasty or the LeCompte manoeuvre.CONCLUSIONSIn patients with absent pulmonary valve syndrome, the Nakata index predicts mortality with a cut-off of 1500 mm2/m2. Lower weight at repair is the only multivariable risk factor for prolonged ventilation. Neither PA plasty nor the LeCompte manoeuvre had a protective effect on these outcomes.

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Risk Factors and Outcomes for Vancomycin-ResistantEnterococcusBloodstream Infection in Children

Infection Control and Hospital Epidemiology ◽

10.1086/655464 ◽

2010 ◽

Vol 31 (10) ◽

pp. 1038-1042 ◽

Cited By ~ 14

Author(s):

Eric J. Haas ◽

Theoklis E. Zaoutis ◽

Priya Prasad ◽

Mingyao Li ◽

Susan E. Coffin

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Length Of Stay ◽

Tertiary Care ◽

Bloodstream Infections ◽

Older Age ◽

The Difference ◽

Nested Case Control ◽

Epidemiological Characteristics

Background and Objective.Enterococcal bloodstream infections (BSIs) cause morbidity and mortality in children. This study aims to describe the epidemiological characteristics of enterococcal BSI, to determine the risk factors for vancomycin-resistantEnterococcus(VRE) BSI, and to compare outcomes of VRE BSI and vancomycin-susceptibleEnterococcus(VSE) BSI in this population.Methods.A retrospective cohort study at a 418-bed tertiary care children's hospital in Philadelphia, Pennsylvania, examined the epidemiological characteristics of children hospitalized with enterococcal BSI during the period from 2001 through 2006. A nested case-control study compared patients with VRE BSI with control patients with VSE BSI. Analysis included regression modeling to identify independent risk factors for VRE BSI.Results.We identified 339 patients with enterococcal BSI during the study period, including 39 patients with VRE infection. Fifty-three patients (16%) died before hospital discharge. Risk factors for VRE included long-term receipt of mechanical ventilation (adjusted odds ratio [OR], 5.40 [95% confidence interval {CI}, 1.28-6.48]), receipt of immunosuppressive medications during the preceding 30 days (adjusted OR, 2.88 [95% CI, 1.40-20.78]), use of vancomycin during the 2 weeks before onset of bacteremia (adjusted OR per day of vancomycin use, 1.25 [95% CI, 1.14-1.38]), and older age (adjusted OR, 1.08 [95% CI, 1.03-1.14]). VRE BSI was not associated with an increased length of stay after onset of bacteremia (0.77 days [95% CI, 0.55-1.07 days]). Mortality was higher for VRE BSI, but the difference was not statistically significant (adjusted OR, 1.94 [95% CI, 0.78-4.8]).Conclusion.Most enterococcal BSI in children was caused by VSE. Risk factors for VRE BSI included receipt of vancomycin, long-term receipt of mechanical ventilation, immunosuppression, and older age. Differences in length of stay and mortality were not detected.

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Infective endocarditis at a tertiary care hospital in South Korea

Heart ◽

10.1136/heartjnl-2020-317265 ◽

2020 ◽

Vol 107 (2) ◽

pp. 135-141 ◽

Cited By ~ 4

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Nam Su Ku ◽

Seung Hyun Lee ◽

Sak Lee ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Care Hospital ◽

Multivariable Logistic Regression ◽

Long Term Prognosis

ObjectiveThe treatment of infective endocarditis (IE) has become more complex with the current myriad healthcare-associated factors and the regional differences in causative organisms. We aimed to investigate the overall trends, microbiological features, and outcomes of IE in South Korea.MethodsA 12-year retrospective cohort study was performed. Poisson regression was used to estimate the time trends of IE incidence and mortality rate. Risk factors for in-hospital mortality were identified with multivariable logistic regression, and model comparison was performed to evaluate the predictive performance of notable risk factors. Kaplan-Meier survival analysis and Cox regression were performed to assess long-term prognosis.ResultsWe included 419 patients with IE, the incidence of which showed an increasing trend (relative risk 1.06, p=0.005), whereas mortality demonstrated a decreasing trend (incidence rate ratio 0.93, p=0.020). The in-hospital mortality rate was 14.6%. On multivariable logistic regression analysis, aortic valve endocarditis (OR 3.18, p=0.001), IE caused by Staphylococcus aureus (OR 2.32, p=0.026), neurological complications (OR 1.98, p=0.031), high Sequential Organ Failure Assessment score (OR 1.22, p=0.023) and high Charlson Comorbidity Index (OR 1.11, p=0.019) were predictors of in-hospital mortality. Surgical intervention for IE was a protective factor against in-hospital mortality (OR 0.25, p<0.001) and was associated with improved long-term prognosis compared with medical treatment only (p<0.001).ConclusionsThe incidence of IE is increasing in South Korea. Although the mortality rate has slightly decreased, it remains high. Surgery has a protective effect with respect to both in-hospital mortality and long-term prognosis in patients with IE.

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146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.221 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S100-S101

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Woon Ji Lee ◽

Hye Seong ◽

Jin young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Logistic Regression ◽

Regression Analysis ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Incidence Rate ◽

Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

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MO850OUTCOMES OF COVID-19 INFECTION IN DIALYSIS PATIENTS IN QATAR: A NATIONWIDE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab098.0042 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Tarek Abdellatif ◽

Abdullah Hamad ◽

Mohamad Alkadi ◽

Essa Abuhelaiqa ◽

Muftah Othman ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Critical Care ◽

Mortality Rate ◽

General Population ◽

Hospital Stay ◽

Laboratory Tests ◽

Length Of Hospital Stay ◽

Dialysis Patients ◽

Risk Of Death

Abstract Background and Aims Patients on maintenance dialysis are more susceptible to COVID-19 and its severe complications. We studied outcomes of COVID-19 infection in dialysis patients in the state of Qatar. Our primary outcome was to determine the mortality rate of dialysis patients with COVID-19 infection and associated risk factors. Our secondary outcomes were to assess the severity of COVID-19 in dialysis patients and its related complications such as the incidence of hypoxia, critical care unit admission, need for mechanical ventilation or inotropes, incidence of acute respiratory distress syndrome (ARDS), and length of hospital stay. Method This was an observational, analytical, retrospective, nationwide study. We included all adult patients on dialysis who tested positive for COVID-19 (PCR assay of nasopharyngeal swab) during the period from February 1, 2020 to July 19, 2020. Patient demographics and clinical features were collected from a national electronic medical record. Laboratory tests were evaluated upon diagnosis and on day 7. Results There were 76 out of 1068 dialysis patients who were diagnosed with COVID-19 (age 56±13.6, 56 hemodialysis and 20 peritoneal dialysis, 56 males). Eleven patients (15%) died during study period. Mortality due to COVID-19 among our dialysis cohort was 100 times higher than that in the general population for the same period (15% vs. 0.15%; OR 114.2 [95% CI: 1.53 to 2.44]; p<0.001). Univariate analysis for risk factors associated with COVID-19-related death in dialysis patients showed minor but statistically significant increases in risks with age (OR 1.07), peak WBC peak level (OR 1.189), AST level at day 7 (OR 1.04), fibrinogen level at day 7 (OR 1.4), D-dimer level on day 7 (OR 1.94), and peak CRP level (OR 1.01). A major increase in the risk of death was noted with atrial fibrillation (OR, 8.7; p=0.008) and hypoxia (OR: 28; p=0.001). High severity of COVID-19 illness in dialysis manifested as 25% of patients required admission to the intensive care unit, 18.4% had ARDS, 17.1% required mechanical ventilation, and 14.5% required inotropes for intractable hypotension or shock. The mean length of hospital stay was 19.2±10.4 days. Laboratory tests were remarkable for severely elevated ferritin, fibrinogen, CRP, and peak IL-6 levels and decreased albumin levels on day 7. Conclusion This is the first study to be conducted at a national level in Qatar exploring COVID-19 in a dialysis population. Dialysis patients had a high mortality rate of COVID-19 infection compared to the general population. Dialysis patients had severe COVID-19 course complicated by prolonged hospitalization and high need for critical care, mechanical ventilation and inotropes. Special care should be done to prevent COVID-19 in dialysis patients to avoid severe complications and mortality.

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Risk factors for clinical progression in patients with COVID-19: a retrospective study of electronic health record data in the United Kingdom

10.1101/2020.05.11.20093096 ◽

2020 ◽

Cited By ~ 3

Author(s):

Robert A Fletcher ◽

Thomas Matcham ◽

Marta Tibúrcio ◽

Arseni Anisimovich ◽

Stojan Jovanović ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Body Temperature ◽

Blood Cell ◽

Severe Disease ◽

C Reactive Protein ◽

Reactive Protein ◽

Multivariable Logistic Regression ◽

D Dimer

Background: The novel coronavirus disease 2019 (COVID-19) outbreak presents a significant threat to global health. A better understanding of patient clinical profiles is essential to drive efficient and timely health service strategies. In this study, we aimed to identify risk factors for a higher susceptibility to symptomatic presentation with COVID-19 and a transition to severe disease. Methods: We analysed data on 2756 patients admitted to Chelsea & Westminster Hospital NHS Foundation Trust between 1st January and 23rd April 2020. We compared differences in characteristics between patients designated positive for COVID-19 and patients designated negative on hospitalisation and derived a multivariable logistic regression model to identify risk factors for predicting risk of symptomatic COVID-19. For patients with COVID-19, we used univariable and multivariable logistic regression to identify risk factors associated with progression to severe disease defined by: 1) admission to the hospital AICU, 2) the need for mechanical ventilation, 3) in-hospital mortality, and 4) at least one measurement of elevated D-dimer (equal or superior to 1,000 ug/L) indicative of increased risk of venous thromboembolism. Results: The patient population consisted of 1148 COVID-19 positive and 1608 COVID-19 negative patients. Age, sex, self-reported ethnicity, C-reactive protein, white blood cell count, respiratory rate, body temperature, and systolic blood pressure formed the most parsimonious model for predicting risk of symptomatic COVID-19 at hospital admission. Among 1148 patients with COVID-19, 116 (10.1%) were admitted to the AICU, 71 (6.2%) required mechanical ventilation, 368 (32.1%) had at least one record of D-dimer levels ≥1,000 μg/L, and 118 patients died. In the multivariable logistic regression, age (OR = 0.953 per 1 year, 95% CI: 0.937-0.968) C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.007), and white blood cell counts (OR = 1.059 per 109/L, 95% CI: 1.010-1.111) were found to be associated with admission to the AICU. Age (OR = 0.973 per 1 year, 95% CI: 0.955-0.990), C-reactive protein (OR = 1.003 per 1 mg/L, 95% CI: 1.000-1.006) and sodium (OR = 0.915 per 1 mmol/L, 0.868-0.962) were associated with mechanical ventilation. Age (OR = 1.023 per 1 year, 95% CI: 1.004-1.043), CRP (OR = 1.004 per 1 mg/L, 95% CI: 1.002-1.006), and body temperature (OR = 0.723 per 1oC, 95% CI: 0.541-0.958) were associated with elevated D-dimer. For mortality, we observed associations with age (OR = 1.060 per 1 year, 95% CI: 1.040-1.082), female sex (OR = 0.442, 95% CI: 0.442, 95% CI: 0.245-0.777), Asian ethnic background (OR = 2.237 vs White ethnic background, 95% CI: 1.111-4.510), C-reactive protein (OR = 1.004 per 1 mg/L, 95% CI: 1.001-1.006), sodium (OR = 1.038 per 1 mmol/L, 95% CI: 1.001-1.006), and respiratory rate (OR = 1.054 per 1 breath/min, 95% CI: 1.024-1.087). Conclusion: Our analysis suggests there are several demographic, clinical and laboratory findings associated with a symptomatic presentation of COVID-19. Moreover, significant associations between patient deterioration were found with age, sex and specific blood markers, chiefly C-reactive protein, and could help early identification of patients at risk of poorer prognosis. Further work is required to clarify the extent to which our observations are relevant beyond current settings.

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Analysis of oral risk-factors for ventilator-associated pneumonia in critically ill patients

10.21203/rs.3.rs-23662/v1 ◽

2020 ◽

Author(s):

Ademar Takahama ◽

Vitoria Iaros de Sousa ◽

Elisa Emi Tanaka ◽

Evelise Ono ◽

Fernanda Akemi Nakanishi Ito ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Physical Examination ◽

Critically Ill ◽

Critically Ill Patients ◽

Cross Sectional Study ◽

Ventilator Associated Pneumonia ◽

Cross Sectional ◽

Logistic Regression Models

Abstract Objective: This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in intensive care units (ICU). Material and Methods: Data were collected from medical records, and a detailed oral physical examination was performed on 663 critically ill patients on mechanical ventilation. Data were statistically analysed using univariate and logistic regression models relating the development of VAP with the oral findings. Results: At oral physical examination, the most frequent findings were tooth loss (568 - 85.67%), coated tongue (422 - 63.65%) and oral bleeding (192 - 28.96%). Patients with a coated tongue or oral bleeding on the first day of ICU hospitalization developed more VAP than did patients without these conditions (20.14% vs 13.69%: p=0.02; 23.44% vs 15.50%: p=0.01, respectively). In the logistic regression, a coated tongue and oral bleeding were considered independent risk factors for VAP development [OR=1.60 (1.02-2.47) and OR=1.59 (1.05 – 2.44), respectively]. Conclusions: The presence of a coated tongue and oral bleeding in ICU admission could be considered markers for the development of VAP. Clinical relevance: The results of this paper reinforces the importance of proper maintenance of oral hygiene before intubation, which may lead to a decrease in the incidence of VAP in the ICU. This is particularly important in the COVID-19 current scenario, where more people are expected to need mechanical ventilation, consequently increasing cases of VAP.

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COVID-19 pneumonia in Galicia (Spain): Impact of prognostic factors and therapies on mortality and need for mechanical ventilation

PLoS ONE ◽

10.1371/journal.pone.0253465 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253465

Author(s):

Luis Pérez-de-Llano ◽

Eva María Romay-Lema ◽

Adolfo Baloira-Villar ◽

Christian Anchorena ◽

María Luisa Torres-Durán ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Logistic Regression ◽

Therapeutic Interventions ◽

Outcome Variable ◽

Multivariable Logistic Regression Analysis ◽

Composite Outcome ◽

Multicenter Observational Study ◽

Risk Of Death ◽

Hospital Beds

Introduction This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. Methods Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. Results A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39–3.63)] and [OR = 3.04 (95% CI: 1.88–4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06–1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91–0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12–0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45–2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15–5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02–1.11)]. Conclusion These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.

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