Service de Réanimation, CH de St BRIEUC, 10, rue Marcel Proust, 22000, Saint-Brieuc, France.
Faculté de Médecine, Université Rennes 1, Biosit, F-35043, Rennes, France.
Eur J Clin Microbiol Infect Dis. 2021 Aug;40(8):1673-1680. doi: 10.1007/s10096-021-04215-4. Epub 2021 Mar 10.
The mortality attributable to ICU-acquired bloodstream infection (BSI) differs between studies due to statistical methods used for cohort matching. Propensity-score matching has never been used to avoid eventual bias when studying BSI attributable mortality in the ICU. We conducted an observational prospective study over a 4-year period, on patients admitted for at least 48 h in 2 intensive care units. Based on risk factors for death in the ICU and for BSI, each patient with BSI was matched with 3 patients without BSI using propensity-score matching. We performed a competitive risk analysis to study BSI mortality attributable fraction. Of 2464 included patients, 71 (2.9%) had a BSI. Propensity-score matching was highly effective and group characteristics were fully balanced. Crude mortality was 36.6% in patients with BSI and 21.6% in propensity-score matched patients (p=0.018). Attributable mortality of BSI was 2.3% [1.2-4.0] and number needed to harm was 6.7. With Fine and Gray model, a higher risk for death was observed in patients with BSI than in propensity-score matched patients (sub distribution Hazard Ratio (sdHR) = 2.11; 95% CI [1.32-3.37] p = 0.002). Patients with BSI had a higher risk for death and BSI attributable mortality fraction was 2.3%.
ICU 获得性血流感染（BSI）导致的死亡率因用于队列匹配的统计方法而异。由于在 ICU 中研究 BSI 归因死亡率时存在潜在偏差，因此从未使用倾向评分匹配来避免这种偏差。我们进行了一项为期 4 年的观察性前瞻性研究，研究对象为在 2 个重症监护病房至少入住 48 小时的患者。基于 ICU 死亡和 BSI 的危险因素，对每位 BSI 患者使用倾向评分匹配与 3 名无 BSI 患者进行匹配。我们进行了竞争风险分析以研究 BSI 归因死亡率。在纳入的 2464 名患者中，71 名（2.9%）发生了 BSI。倾向评分匹配非常有效，组间特征完全平衡。BSI 患者的粗死亡率为 36.6%，倾向评分匹配患者的死亡率为 21.6%（p=0.018）。BSI 的归因死亡率为 2.3%[1.2-4.0]，需要伤害的人数为 6.7。采用 Fine 和 Gray 模型，BSI 患者的死亡风险高于倾向评分匹配患者（亚分布风险比（sdHR）=2.11；95%CI[1.32-3.37]，p=0.002）。BSI 患者的死亡风险更高，BSI 归因死亡率为 2.3%。
