Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Lancet Infect Dis. 2013 Aug;13(8):665-71. doi: 10.1016/S1473-3099(13)70081-1. Epub 2013 Apr 25.
Estimating attributable mortality of ventilator-associated pneumonia has been hampered by confounding factors, small sample sizes, and the difficulty of doing relevant subgroup analyses. We estimated the attributable mortality using the individual original patient data of published randomised trials of ventilator-associated pneumonia prevention.
We identified relevant studies through systematic review. We analysed individual patient data in a one-stage meta-analytical approach (in which we defined attributable mortality as the ratio between the relative risk reductions [RRR] of mortality and ventilator-associated pneumonia) and in competing risk analyses. Predefined subgroups included surgical, trauma, and medical patients, and patients with different categories of severity of illness scores.
Individual patient data were available for 6284 patients from 24 trials. The overall attributable mortality was 13%, with higher mortality rates in surgical patients and patients with mid-range severity scores at admission (ie, acute physiology and chronic health evaluation score [APACHE] 20-29 and simplified acute physiology score [SAPS 2] 35-58). Attributable mortality was close to zero in trauma, medical patients, and patients with low or high severity of illness scores. Competing risk analyses could be done for 5162 patients from 19 studies, and the overall daily hazard for intensive care unit (ICU) mortality after ventilator-associated pneumonia was 1·13 (95% CI 0·98-1·31). The overall daily risk of discharge after ventilator-associated pneumonia was 0·74 (0·68-0·80), leading to an overall cumulative risk for dying in the ICU of 2·20 (1·91-2·54). Highest cumulative risks for dying from ventilator-associated pneumonia were noted for surgical patients (2·97, 95% CI 2·24-3·94) and patients with mid-range severity scores at admission (ie, cumulative risks of 2·49 [1·81-3·44] for patients with APACHE scores of 20-29 and 2·72 [1·95-3·78] for those with SAPS 2 scores of 35-58).
The overall attributable mortality of ventilator-associated pneumonia is 13%, with higher rates for surgical patients and patients with a mid-range severity score at admission. Attributable mortality is mainly caused by prolonged exposure to the risk of dying due to increased length of ICU stay.
None.
呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）的归因死亡率受到混杂因素、样本量小以及进行相关亚组分析的困难的影响。我们使用已发表的呼吸机相关性肺炎预防随机试验的个体原始患者数据来估计归因死亡率。
我们通过系统评价确定了相关研究。我们采用单阶段荟萃分析方法（其中我们将归因死亡率定义为死亡率和呼吸机相关性肺炎的相对风险降低[RRR]之间的比值）和竞争风险分析来分析个体患者数据。预设的亚组包括手术、创伤和内科患者，以及不同严重程度评分类别的患者。
24 项试验中有 6284 名患者的个体患者数据可用。总体归因死亡率为 13%，手术患者和入院时中度严重程度评分患者（即急性生理学和慢性健康评估评分[APACHE] 20-29 分和简化急性生理学评分[SAPS 2] 35-58 分）的死亡率更高。在创伤、内科患者以及低或高严重程度评分患者中，归因死亡率接近零。可以对来自 19 项研究的 5162 名患者进行竞争风险分析，呼吸机相关性肺炎后 ICU 死亡率的总体日风险为 1.13（95%CI 0.98-1.31）。呼吸机相关性肺炎后出院的总体日风险为 0.74（0.68-0.80），导致 ICU 内死亡的总累积风险为 2.20（1.91-2.54）。呼吸机相关性肺炎死亡的最高累积风险见于手术患者（2.97，95%CI 2.24-3.94）和入院时中度严重程度评分患者（即，APACHE 评分 20-29 分患者的累积风险为 2.49[1.81-3.44]，SAPS 2 评分 35-58 分患者的累积风险为 2.72[1.95-3.78]）。
呼吸机相关性肺炎的总体归因死亡率为 13%，手术患者和入院时中度严重程度评分患者的死亡率更高。归因死亡率主要是由于 ICU 住院时间延长而导致死亡风险增加。
归因于呼吸机相关性肺炎的死亡率主要是由于 ICU 住院时间延长导致死亡风险增加所致。
无。
