Publicação
Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections
| Resumo: | Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. |
|---|---|
| Autores principais: | Reyes, Luis Felipe |
| Outros Autores: | Torres, Antoni; Olivella-Gomez, Juan; Ibáñez-Prada, Elsa D.; Nseir, Saad; Ranzani, Otavio T.; Povoa, Pedro; Povoa, Pedro; Diaz, Emilio; Schultz, Marcus J.; Rodríguez, Alejandro H.; Serrano-Mayorga, Cristian C.; De Pascale, Gennaro; Navalesi, Paolo; Skoczynski, Szymon; Esperatti, Mariano; Coelho, Luis Miguel; Cortegiani, Andrea; Aliberti, Stefano; Caricato, Anselmo; Salzer, Helmut J.F.; Ceccato, Adrian; Civljak, Rok; Soave, Paolo Maurizio; Luyt, Charles Edouard; Korkmaz Ekren, Pervin; Rios, Fernando; Masclans, Joan Ramon; Marin, Judith; Iglesias-Moles, Silvia; Nava, Stefano; Chiumello, Davide; Bos, Lieuwe D.; Artigas, Antonio; Froes, Filipe; Grimaldi, David; Panigada, Mauro; Taccone, Fabio Silvio; Antonelli, Massimo; Martin-Loeches, Ignacio |
| Assunto: | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| Ano: | 2025 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Universidade Nova de Lisboa |
| Idioma: | inglês |
| Origem: | Repositório Institucional da UNL |
| _version_ | 1868983833632702464 |
|---|---|
| author | Reyes, Luis Felipe |
| author2 | Torres, Antoni Olivella-Gomez, Juan Ibáñez-Prada, Elsa D. Nseir, Saad Ranzani, Otavio T. Povoa, Pedro Povoa, Pedro Diaz, Emilio Schultz, Marcus J. Rodríguez, Alejandro H. Serrano-Mayorga, Cristian C. De Pascale, Gennaro Navalesi, Paolo Skoczynski, Szymon Esperatti, Mariano Coelho, Luis Miguel Cortegiani, Andrea Aliberti, Stefano Caricato, Anselmo Salzer, Helmut J.F. Ceccato, Adrian Civljak, Rok Soave, Paolo Maurizio Luyt, Charles Edouard Korkmaz Ekren, Pervin Rios, Fernando Masclans, Joan Ramon Marin, Judith Iglesias-Moles, Silvia Nava, Stefano Chiumello, Davide Bos, Lieuwe D. Artigas, Antonio Froes, Filipe Grimaldi, David Panigada, Mauro Taccone, Fabio Silvio Antonelli, Massimo Martin-Loeches, Ignacio |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_facet | Reyes, Luis Felipe Torres, Antoni Olivella-Gomez, Juan Ibáñez-Prada, Elsa D. Nseir, Saad Ranzani, Otavio T. Povoa, Pedro Povoa, Pedro Diaz, Emilio Schultz, Marcus J. Rodríguez, Alejandro H. Serrano-Mayorga, Cristian C. De Pascale, Gennaro Navalesi, Paolo Skoczynski, Szymon Esperatti, Mariano Coelho, Luis Miguel Cortegiani, Andrea Aliberti, Stefano Caricato, Anselmo Salzer, Helmut J.F. Ceccato, Adrian Civljak, Rok Soave, Paolo Maurizio Luyt, Charles Edouard Korkmaz Ekren, Pervin Rios, Fernando Masclans, Joan Ramon Marin, Judith Iglesias-Moles, Silvia Nava, Stefano Chiumello, Davide Bos, Lieuwe D. Artigas, Antonio Froes, Filipe Grimaldi, David Panigada, Mauro Taccone, Fabio Silvio Antonelli, Massimo Martin-Loeches, Ignacio |
| author_role | author |
| contributor_name_str_mv | NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) MDPI - Multidisciplinary Digital Publishing Institute RUN |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Reyes, Luis Felipe\"},{\"Person.name\":\"Torres, Antoni\"},{\"Person.name\":\"Olivella-Gomez, Juan\"},{\"Person.name\":\"Ibáñez-Prada, Elsa D.\"},{\"Person.name\":\"Nseir, Saad\"},{\"Person.name\":\"Ranzani, Otavio T.\"},{\"Person.name\":\"Povoa, Pedro\"},{\"Person.name\":\"Povoa, Pedro\",\"Person.identifier.orcid\":\"0000-0002-7069-7304\"},{\"Person.name\":\"Diaz, Emilio\"},{\"Person.name\":\"Schultz, Marcus J.\"},{\"Person.name\":\"Rodríguez, Alejandro H.\"},{\"Person.name\":\"Serrano-Mayorga, Cristian C.\"},{\"Person.name\":\"De Pascale, Gennaro\"},{\"Person.name\":\"Navalesi, Paolo\"},{\"Person.name\":\"Skoczynski, Szymon\"},{\"Person.name\":\"Esperatti, Mariano\"},{\"Person.name\":\"Coelho, Luis Miguel\"},{\"Person.name\":\"Cortegiani, Andrea\"},{\"Person.name\":\"Aliberti, Stefano\"},{\"Person.name\":\"Caricato, Anselmo\"},{\"Person.name\":\"Salzer, Helmut J.F.\"},{\"Person.name\":\"Ceccato, Adrian\"},{\"Person.name\":\"Civljak, Rok\"},{\"Person.name\":\"Soave, Paolo Maurizio\"},{\"Person.name\":\"Luyt, Charles Edouard\"},{\"Person.name\":\"Korkmaz Ekren, Pervin\"},{\"Person.name\":\"Rios, Fernando\"},{\"Person.name\":\"Masclans, Joan Ramon\"},{\"Person.name\":\"Marin, Judith\"},{\"Person.name\":\"Iglesias-Moles, Silvia\"},{\"Person.name\":\"Nava, Stefano\"},{\"Person.name\":\"Chiumello, Davide\"},{\"Person.name\":\"Bos, Lieuwe D.\"},{\"Person.name\":\"Artigas, Antonio\"},{\"Person.name\":\"Froes, Filipe\"},{\"Person.name\":\"Grimaldi, David\"},{\"Person.name\":\"Panigada, Mauro\"},{\"Person.name\":\"Taccone, Fabio Silvio\"},{\"Person.name\":\"Antonelli, Massimo\"},{\"Person.name\":\"Martin-Loeches, Ignacio\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) MDPI - Multidisciplinary Digital Publishing Institute RUN |
| datacite.creators.creator.creatorName.fl_str_mv | Reyes, Luis Felipe Torres, Antoni Olivella-Gomez, Juan Ibáñez-Prada, Elsa D. Nseir, Saad Ranzani, Otavio T. Povoa, Pedro Povoa, Pedro Diaz, Emilio Schultz, Marcus J. Rodríguez, Alejandro H. Serrano-Mayorga, Cristian C. De Pascale, Gennaro Navalesi, Paolo Skoczynski, Szymon Esperatti, Mariano Coelho, Luis Miguel Cortegiani, Andrea Aliberti, Stefano Caricato, Anselmo Salzer, Helmut J.F. Ceccato, Adrian Civljak, Rok Soave, Paolo Maurizio Luyt, Charles Edouard Korkmaz Ekren, Pervin Rios, Fernando Masclans, Joan Ramon Marin, Judith Iglesias-Moles, Silvia Nava, Stefano Chiumello, Davide Bos, Lieuwe D. Artigas, Antonio Froes, Filipe Grimaldi, David Panigada, Mauro Taccone, Fabio Silvio Antonelli, Massimo Martin-Loeches, Ignacio |
| datacite.date.Accepted.fl_str_mv | 2025-02-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2025-03-27T21:13:20Z |
| datacite.date.embargoed.fl_str_mv | 2025-03-27T21:13:20Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| datacite.titles.title.fl_str_mv | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections An ENIRRI Analysis |
| dc.contributor.none.fl_str_mv | NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM) MDPI - Multidisciplinary Digital Publishing Institute RUN |
| dc.creator.none.fl_str_mv | Reyes, Luis Felipe Torres, Antoni Olivella-Gomez, Juan Ibáñez-Prada, Elsa D. Nseir, Saad Ranzani, Otavio T. Povoa, Pedro Povoa, Pedro Diaz, Emilio Schultz, Marcus J. Rodríguez, Alejandro H. Serrano-Mayorga, Cristian C. De Pascale, Gennaro Navalesi, Paolo Skoczynski, Szymon Esperatti, Mariano Coelho, Luis Miguel Cortegiani, Andrea Aliberti, Stefano Caricato, Anselmo Salzer, Helmut J.F. Ceccato, Adrian Civljak, Rok Soave, Paolo Maurizio Luyt, Charles Edouard Korkmaz Ekren, Pervin Rios, Fernando Masclans, Joan Ramon Marin, Judith Iglesias-Moles, Silvia Nava, Stefano Chiumello, Davide Bos, Lieuwe D. Artigas, Antonio Froes, Filipe Grimaldi, David Panigada, Mauro Taccone, Fabio Silvio Antonelli, Massimo Martin-Loeches, Ignacio |
| dc.date.Accepted.fl_str_mv | 2025-02-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2025-03-27T21:13:20Z |
| dc.date.embargoed.fl_str_mv | 2025-03-27T21:13:20Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10362/181546 |
| dc.language.none.fl_str_mv | eng |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| dc.title.fl_str_mv | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections An ENIRRI Analysis |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach. |
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| identifier.url.fl_str_mv | http://hdl.handle.net/10362/181546 |
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| language | eng |
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| person_str_mv | Reyes, Luis Felipe Torres, Antoni Olivella-Gomez, Juan Ibáñez-Prada, Elsa D. Nseir, Saad Ranzani, Otavio T. Povoa, Pedro Povoa, Pedro Povoa, Pedro https://www.ciencia-id.pt/0C16-5CF9-9238 0C16-5CF9-9238 http://orcid.org/0000-0002-7069-7304 0000-0002-7069-7304 Diaz, Emilio Schultz, Marcus J. Rodríguez, Alejandro H. Serrano-Mayorga, Cristian C. De Pascale, Gennaro Navalesi, Paolo Skoczynski, Szymon Esperatti, Mariano Coelho, Luis Miguel Cortegiani, Andrea Aliberti, Stefano Caricato, Anselmo Salzer, Helmut J.F. Ceccato, Adrian Civljak, Rok Soave, Paolo Maurizio Luyt, Charles Edouard Korkmaz Ekren, Pervin Rios, Fernando Masclans, Joan Ramon Marin, Judith Iglesias-Moles, Silvia Nava, Stefano Chiumello, Davide Bos, Lieuwe D. Artigas, Antonio Froes, Filipe Grimaldi, David Panigada, Mauro Taccone, Fabio Silvio Antonelli, Massimo Martin-Loeches, Ignacio |
| publishDate | 2025 |
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| spelling | engenBackground: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach.application/pdfenFactors Associated with Mortality in Nosocomial Lower Respiratory Tract InfectionsSubtitleenAn ENIRRI AnalysisReyes, Luis FelipeTorres, AntoniOlivella-Gomez, JuanIbáñez-Prada, Elsa D.Nseir, SaadRanzani, Otavio T.Povoa, PedroPersonalPovoa, PedroDSpacehttp://dspace.org/items/04ec38ba-be1e-46e5-8007-0e65a557d0f4DSpacehttp://dspace.org/items/04ec38ba-be1e-46e5-8007-0e65a557d0f4PovoaPedroCiência IDhttps://www.ciencia-id.pt0C16-5CF9-9238ORCIDhttp://orcid.org0000-0002-7069-7304Scopus Author IDhttps://www.scopus.com6602772147Scopus Author IDhttps://www.scopus.com57515497300Diaz, EmilioSchultz, Marcus J.Rodríguez, Alejandro H.Serrano-Mayorga, Cristian C.De Pascale, GennaroNavalesi, PaoloSkoczynski, SzymonEsperatti, MarianoCoelho, Luis MiguelCortegiani, AndreaAliberti, StefanoCaricato, AnselmoSalzer, Helmut J.F.Ceccato, AdrianCivljak, RokSoave, Paolo MaurizioLuyt, Charles EdouardKorkmaz Ekren, PervinRios, FernandoMasclans, Joan RamonMarin, JudithIglesias-Moles, SilviaNava, StefanoChiumello, DavideBos, Lieuwe D.Artigas, AntonioFroes, FilipeGrimaldi, DavidPanigada, MauroTaccone, Fabio SilvioAntonelli, MassimoMartin-Loeches, IgnacioNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)MDPI - Multidisciplinary Digital Publishing InstituteHostingInstitutionOrganizationalRUNe-mailmailto:run@unl.ptrun@unl.ptISSNIsPartOf2079-6382URNIsPartOfPURE: 112229005URNIsPartOfPURE UUID: e2df1fdf-419e-439e-88e4-9e141bfa9339URNIsPartOfScopus: 85219196945URNIsPartOfWOS: 001429872000001DOIIsPartOf10.3390/antibiotics140201272025-03-27T21:13:20Z2025-022025-02-01T00:00:00ZHandlehttp://hdl.handle.net/10362/181546http://purl.org/coar/access_right/c_abf2open accesscritical caremechanical ventilationnosocomial lower respiratory tract infectionsMicrobiologyBiochemistryPharmacology, Toxicology and Pharmaceutics(all)Microbiology (medical)Infectious DiseasesPharmacology (medical)SDG 3 - Good Health and Well-being569836 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://run.unl.pt/bitstreams/3555367c-2a34-4d0a-a3c9-c189facc04d3/download |
| spellingShingle | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections Reyes, Luis Felipe critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| status | SINGLETON |
| subject.fl_str_mv | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| title | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| title_full | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| title_fullStr | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| title_full_unstemmed | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| title_short | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| title_sort | Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections |
| topic | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| topic_facet | critical care mechanical ventilation nosocomial lower respiratory tract infections Microbiology Biochemistry Pharmacology, Toxicology and Pharmaceutics(all) Microbiology (medical) Infectious Diseases Pharmacology (medical) SDG 3 - Good Health and Well-being |
| url | http://hdl.handle.net/10362/181546 |
| visible | 1 |