Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models

摘要: PURPOSE: Methods for estimating the excess mortality attributable to ventilator-associated pneumonia (VAP) should handle VAP as a time-dependent covariate, since probability of experiencing increases with time on mechanical ventilation. VAP-attributable (VAP-AM) varies definitions, case-mix, causative microorganisms, and treatment adequacy. Our objectives here were compare VAP-AM estimates obtained using traditional cohort analysis, multistate progressive disability model, matched-cohort analysis; according characteristics. METHODS: We used data from 2,873 mechanically ventilated patients in Outcomerea((R)) database. Among these 12 intensive care units, 434 (15.1%) experienced VAP; remaining patients, 1,969 (68.5%) discharged alive 470 (16.4%) died. With was 8.1% (95% confidence interval [95%CI], 3.1-13.1%) 120 days' complete observation, compared 10.4% (5.6-24.5%) approach (2,769 patients) matching ventilation duration followed by conditional logistic regression. higher surgical intermediate (but not high) Simplified Acute Physiologic Score II values at ICU admission. significantly influenced but resistance microorganisms. Higher Logistic Organ Dysfunction score onset dramatically increased (to 31.9% scores above 7). CONCLUSION: A model that appropriately handled event produced lower than varied widely case-mix. Disease severity markedly VAP-AM; this may contribute variability previous estimates.