碳青霉烯耐药感染对机械通气急性呼吸窘迫综合征患者死亡率的影响：与低氧血症严重程度的比较-一项观察性研究

IF 2.3 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-01-22 DOI:10.1016/j.cegh.2025.101947

Thejesh Srinivas , Shwethapriya R , Gagana Hanumaiah , Pratibha Todur , Souvik Chaudhuri , Ganesh Paramasivam , Prithvishree Ravindra , Vinutha R. Bhat , Sagar Shanmukhappa Maddani , Shobha U. Kamath , Danavath Nagendra , Vishwas P , Likith Hanumaiah , Pratik Paran Medhi , Prabha Prakash

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引用次数: 0

摘要

对急性呼吸窘迫综合征（ARDS）不良后果的预测已经从肺器官功能障碍转向肺外器官功能障碍。随着多药耐药性的增加，碳青霉烯耐药感染（CRI）可能使ARDS复杂化。CRI作为预后预测因子的重要性是至关重要的。本研究旨在评估CRI对ARDS患者的影响。该二级分析纳入了2020年9月至2024年7月在单中心三级医疗机构进行的两项前瞻性观察性研究中355名接受有创机械通气的成年ARDS患者。主要终点是ICU死亡率。从临床记录中记录了人口统计学细节、器官功能障碍评分、氧合值、基于柏林标准的ARDS分类、炎症生物标志物和ICU结果。回顾CRI患者的培养敏感性报告，并分析CRI与死亡率结局的关系。采用单因素和多因素logistic回归分析及人工神经网络模型对死亡结局进行分析。结果32.9%的ARDS患者存在scri。多变量logistic回归发现CRI是ICU死亡率的独立预测因子（p值<；0.001，校正OR 3.13, 95%CI[1.752-5.588]）。人工神经网络分析显示，急性生理和慢性健康评估（APACHE）评分、序期器官衰竭评估（SOFA）评分和CRI对预测死亡率具有归一化重要性（分别为100%、84.5%和83.4%）。合并独立预测因子- cri、APACHE II评分≥17和SOFA评分≥9，形成“CARAS”分类，其死亡率较高（76.6%，p值<；0.001）。合并CRI的轻中度ARDS死亡率为59.4%，未合并CRI的死亡率为41.1% （p值= 0.013，卡方检验）。结论与低氧血症严重程度相比，cri是ARDS患者死亡率的独立预测因子。“CARAS”阳性患者（CRI APACHE II评分≥17，SOFA评分≥9）的死亡率明显高于非CARAS患者。与严重ARDS的死亡率增加相比，CRI显著增加了轻中度ARDS的死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Impact of carbapenem-resistant infections on mortality in mechanically ventilated acute respiratory distress syndrome patients: A comparison with hypoxemia severity – An observational study

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Impact of carbapenem-resistant infections on mortality in mechanically ventilated acute respiratory distress syndrome patients: A comparison with hypoxemia severity – An observational study

Introduction

There has been a shift in predicting adverse outcomes in acute respiratory distress syndrome (ARDS) from pulmonary to extra-pulmonary organ dysfunction. With rising multi-drug resistance, carbapenem-resistant infections (CRI) may complicate ARDS. The significance of CRI as an outcome predictor is crucial. This study aimed to assess the impact of CRI in ARDS patients.

Methods

This secondary analysis included 355 adult ARDS patients on invasive mechanical ventilation from two prospective observational studies conducted between September 2020 and July 2024 at a single-center tertiary care facility. The primary outcome was ICU mortality. Demographic details, organ dysfunction scores, oxygenation values, ARDS classification based on the Berlin criteria, inflammatory biomarkers, and ICU outcomes were noted from clinical records. Patients’ culture sensitivity reports were reviewed for CRI, and the association of CRI with mortality outcomes was analyzed. Univariate and multivariable logistic regression analyses and artificial neural network model, were employed to analyze mortality outcomes.

Results

CRI was present in 32.9 % of ARDS patients. Multivariable logistic regression identified CRI as an independent predictor of ICU mortality (P-value<0.001, adjusted OR 3.13, 95%CI [1.752–5.588]). Artificial neural network analysis showed that acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, and CRI had the normalized importance (100 %, 84.5 %, and 83.4 %, respectively) in predicting mortality. Independent predictors—CRI, APACHE II score ≥ 17, and SOFA score ≥9—were combined to create the “CARAS” categorization, which had a higher mortality (76.6 %, P-value<0.001). Mortality in mild-moderate ARDS with CRI was 59.4 % versus 41.1 % without CRI (P-value = 0.013, Chi-Square test).

Conclusion

CRI is an independent predictor of mortality in ARDS patients, compared to hypoxemia severity. “CARAS” positive patients (CRI with APACHE II score ≥17 and SOFA score ≥9) had significantly higher mortality than non-CARAS. CRI significantly increases mortality in mild-moderate ARDS compared to increase in mortality in severe ARDS.

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.