Hauffe Till, Nalbant Bahar, Wild Lennart, Müller Mattia, Schöni Aline, Andermatt Rea, Buhlmann Alix, Stahl Klaus, Putensen Christian, Bode Christian, Seeliger Benjamin, David Sascha
Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Crit Care. 2025 Aug 20;29(1):372. doi: 10.1186/s13054-025-05524-2.
Legionella pneumonia (LP) is a major cause of severe community-acquired pneumonia (CAP) that can lead to acute respiratory distress syndrome (ARDS) with high morbidity and mortality. ARDS may necessitate extracorporeal membrane oxygenation (ECMO) support, and evidence is limited about benefits of ECMO in LP. Therefore, we sought to analyze the clinical course, outcomes and predictive factors of ECMO patients with ARDS due to LP compared to non ECMO patients.
This retrospective, multicenter cohort study analyzed ICU patients with LP across three tertiary university hospitals (Zurich, Switzerland; Hannover & Bonn, Germany) from 2013 to 2023. We examined demographics, clinical characteristics, and outcomes, with a focus on ECMO utilization and its impact on mortality.
A total of 110 patients were included, with a median age of 60 years and 75% male. ECMO support was initiated in 40%. The overall 28-day mortality did not differ between groups, with 21% without ECMO vs. 25% with ECMO (OR 1.24 (0.49-3.05, p = 0.64), despite higher degree of organ failure in the ECMO group (SOFA score 24 h after ICU admission 9 vs. 12, p < 0.001). Only 57% of patients had adequate antibiotic LP coverage at ICU admission with no differences in outcome. Multivariable analysis found hospital acquired LP (OR 28.4 (3.44-614), p = 0.006) and lactate (OR 1.31 (1.05-1.75), p = 0.031) as independent risk factor for 28-day mortality.
Patients suffering from LP requiring ECMO support had similar mortality rates compared to LP patients without ECMO support, despite higher SOFA scores. In addition, LP-induced respiratory failure requiring ECMO had a lower mortality rate compared to the published literature on the overall ARDS population. This indirect indication of a potential survival benefit may support bedside clinicians in their decision-making regarding ECMO initiation or withholding.
军团菌肺炎（LP）是严重社区获得性肺炎（CAP）的主要病因，可导致急性呼吸窘迫综合征（ARDS），发病率和死亡率很高。ARDS可能需要体外膜肺氧合（ECMO）支持，而关于ECMO在LP中的益处的证据有限。因此，我们试图分析因LP导致ARDS的ECMO患者与非ECMO患者的临床病程、结局和预测因素。
这项回顾性多中心队列研究分析了2013年至2023年期间瑞士苏黎世、德国汉诺威和波恩三家三级大学医院的LP重症监护病房（ICU）患者。我们检查了人口统计学、临床特征和结局，重点是ECMO的使用及其对死亡率的影响。
共纳入110例患者，中位年龄60岁，男性占75%。40%的患者开始接受ECMO支持。两组的28天总体死亡率无差异，未接受ECMO治疗的患者为21%，接受ECMO治疗的患者为25%（比值比1.24（0.49 - 3.05，p = 0.64）），尽管ECMO组的器官衰竭程度更高（ICU入院后24小时序贯器官衰竭评估（SOFA）评分分别为9分和12分，p < 0.001）。只有57%的患者在ICU入院时接受了足够的抗LP抗生素治疗，结局无差异。多变量分析发现医院获得性LP（比值比28.4（范围3.44 - 614），p = 0.006）和乳酸水平（比值比1.31（1.05 - 1.75），p = 0.031）是28天死亡率的独立危险因素。
尽管SOFA评分更高，但需要ECMO支持的LP患者与未接受ECMO支持的LP患者死亡率相似。此外，与已发表的关于总体ARDS人群的文献相比，因LP导致呼吸衰竭需要ECMO治疗的患者死亡率更低。这种潜在生存益处的间接迹象可能有助于床边临床医生在决定是否启动或停止ECMO时做出决策。
