Crit Care:呼吸机相关性肺炎与COVID-19患者死亡率之间的关系

2021-05-27 MedSci原创 MedSci原创

VAP与SARS-CoV-2患者的28天死亡率增加显著相关。但是,与流感性肺炎患者或无病毒感染患者相比,SARS-CoV-2肺炎并未显著改变VAP与28天死亡率之间的关系。

SARS-CoV-2感染患者发生呼吸机相关性肺炎(VAP)的风险更高。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,尚无研究评估该人群中VAP与死亡率之间的关系,或比较SARS-CoV-2患者与其他人群之间的这种关系。

该研究的主要目的旨在明确SARS-CoV-2患者VAP与死亡率之间的关系。

研究人员使用临床、放射学和定量微生物学标准诊断了VAP,并使用单变量和多变量边际Cox回归模型(具有机械通气时间和ICU停留时间的特定原因风险)来比较研究组间的结局。拔管和ICU出院被认为是感兴趣的事件,而死亡率则被认为是竞争性事件。

figure2

VAP与结局之间的关系

在1576例纳入的患者中,568例为SARS-CoV-2肺炎患者,482例为流感性肺炎患者,526例在ICU入院时没有病毒感染的证据。VAP与SARS-CoV-2患者(校正后的HR为1.70(95%CI为1.16–2.47,p=0.006)和流感患者(1.75(1.03-3.02),p=0.045)较高的28天死亡率升高显著相关,但在无病毒感染患者中则无关(1.07(0.64–1.78),p=0.79)。VAP与SARS-CoV-2患者的机械通气时间延长相关,但与流感患者或无病毒感染患者无关。在3个研究组中,VAP与ICU停留时间显著延长相关。三组患者之间在VAP相关结局的异质性方面没有显著差异,这表明研究组之间VAP对死亡率的影响没有差异。

由此可见,VAP与SARS-CoV-2患者的28天死亡率增加显著相关。但是,与流感性肺炎患者或无病毒感染患者相比,SARS-CoV-2肺炎并未显著改变VAP与28天死亡率之间的关系

原始出处:

Saad Nseir.et al.Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort.Critical Care.2021.https://ccforum.biomedcentral.com/articles/10.1186/s13054-021-03588-4

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    2021-05-29 Boyinsh
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