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    Influenza and associated co-infections in critically ill immunosuppressed patients.

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    Authors
    Martin-Loeches, Ignacio
    Lemiale, Virginie
    Geoghegan, Pierce
    McMahon, Mary AISLING
    Pickkers, Peter
    Soares, Marcio
    Perner, Anders
    Meyhoff, Tine Sylvest
    Bukan, Ramin Brandt
    Rello, Jordi
    Bauer, Philippe R
    van de Louw, Andry
    Taccone, Fabio Silvio
    Salluh, Jorge
    Hemelaar, Pleun
    Schellongowski, Peter
    Rusinova, Katerina
    Terzi, Nicolas
    Mehta, Sangeeta
    Antonelli, Massimo
    Kouatchet, Achille
    Klepstad, Pål
    Valkonen, Miia
    Landburg, Precious Pearl
    Barratt-Due, Andreas
    Bruneel, Fabrice
    Pène, Frédéric
    Metaxa, Victoria
    Moreau, Anne Sophie
    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
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    Issue Date
    2019-05-02
    Keywords
    Critical illness
    Immunosuppression
    INFLUENZA
    Respiratory failure
    Sepsis
    
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    Show full item record
    Journal
    Critical care (London, England)
    URI
    http://hdl.handle.net/10147/627162
    DOI
    10.1186/s13054-019-2425-6
    PubMed ID
    31046842
    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.
    Item Type
    Article
    Language
    en
    EISSN
    1466-609X
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13054-019-2425-6
    Scopus Count
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