Background
Methods
Study design and population
Definitions
Ventilator-associated lower respiratory tract infection
Outcomes
Statistical analysis
SARS-CoV-2 pneumonia | Influenza pneumonia | No viral infection | ||||
---|---|---|---|---|---|---|
Alive (n = 402) | Dead (n = 166) | Alive (n = 350) | Dead (n = 132) | Alive (n = 344) | Dead (n = 182) | |
Age, yearsa | 62 (53–70) | 70 (62–78) | 61 (52–70) | 65 (54–72) | 63 (52–72) | 70 (60–76) |
Men | 281/402 (69.9) | 126/166 (75.9) | 219/350 (62.6) | 79/131 (60.3) | 239/342 (69.9) | 114/182 (62.6) |
Body mass index, kg/m2 b | 28.7 (25.5–33.6) | 29.1 (26.0–33.0) | 27.5 (23.1–32.3) | 27.6 (23.5–31.7) | 26.3 (22.7–29.8) | 26.9 (23.2–33.3) |
Severity scores | ||||||
SAPS IIc | 38 (31–51) | 48 (38–61) | 48 (37–60) | 58 (45–72) | 51 (39–63) | 63 (51–73) |
SOFA scored | 6 (3–8) | 7 (4–10) | 8 (5–10) | 10 (7–13) | 8 (5–11) | 9 (7–12) |
Comorbidity scores | ||||||
MacCabe classification | ||||||
Non-fatal | 347/382 (90.8) | 128/161 (79.5) | 249/332 (75.0) | 75/124 (60.5) | 216/318 (67.9) | 99/171 (57.9) |
Fatal < 5 years | 33/382 (8.6) | 29/161 (18.0) | 78/332 (23.5) | 36/124 (29.0) | 90/318 (28.3) | 47/171 (27.5) |
Fatal < 1 year | 2/382 (0.5) | 4/161 (2.5) | 5/332 (1.5) | 13/124 (10.5) | 12/318 (3.8) | 25/171 (14.6) |
Charlson Comorbidity Indexe | 2 (1–3) | 4 (2–5) | 3 (2–5) | 4 (2–6) | 3 (2–5) | 5 (3–6) |
Chronic diseases | ||||||
Diabetes mellitus | 113/399 (28.3) | 55/166 (33.1) | 72/344 (20.9) | 32/130 (24.6) | 82/338 (24.3) | 50/181 (27.6) |
Chronic renal failure | 11/395 (2.8) | 22/164 (13.4) | 25/346 (7.2) | 14/129 (10.9) | 22/339 (6.5) | 23/182 (12.6) |
Cardiovascular disease | 59/396 (14.9) | 44/164 (26.8) | 80/346 (23.1) | 37/130 (28.5) | 72/337 (21.4) | 62/181 (34.3) |
Chronic heart failure | 12/394 (3.0) | 9/164 (5.5) | 19/345 (5.5) | 18/130 (13.8) | 24/336 (7.1) | 26/182 (14.3) |
COPD | 26/396 (6.6) | 11/164 (6.7) | 96/344 (27.9) | 33/131 (25.2) | 63/339 (18.6) | 35/182 (19.2) |
Chronic respiratory failure | 12/394 (3.0) | 8/164 (4.9) | 56/344 (16.3) | 11/131 (8.4) | 28/336 (8.3) | 21/182 (11.5) |
Cirrhosis | 6/395 (1.5) | 2/164 (1.2) | 10/345 (2.9) | 6/130 (4.6) | 18/335 (5.4) | 18/181 (9.9) |
Immunosuppression | 29/395 (7.3) | 23/164 (14.0) | 61/348 (17.5) | 46/131 (35.1) | 71/340 (20.9) | 46/180 (25.6) |
Active smoking | 20/396 (5.1) | 9/164 (5.5) | 122/346 (35.3) | 27/130 (20.8) | 102/337 (30.3) | 35 /182 (19.2) |
Alcohol abuse | 29/394 (7.4) | 5/164 (3.0) | 65/345 (18.8) | 20/130 (15.4) | 89/337 (26.4) | 43/182 (23.6) |
Location before ICU admission | ||||||
Home | 187/402 (46.5) | 84/166 (50.6) | 212/349 (60.7) | 63/132 (47.7) | 180/344 (52.3) | 85/182 (46.7) |
Hospital ward | 154/402 (38.3) | 61/166 (36.7) | 104/349 (29.8) | 53/132 (40.2) | 147/344 (42.7) | 83/182 (45.6) |
Another ICU | 61/402 (15.2) | 21/166 (12.7) | 33/349 (9.5) | 16/132 (12.1) | 17/344 (4.9) | 14/182 (7.7) |
Admission category | ||||||
Medical | 401/402 (99.8) | 166/166 (100.0) | 348/350 (99.4) | 132/132 (100.0) | 302/344 (87.8) | 165/182 (90.7) |
Surgical | 0/402 (0.0) | 0/166 (0.0) | 0/350 (0.0) | 0/132 (0.0) | 11/344 (3.2) | 6/182 (3.3) |
Trauma | 1/402 (0.2) | 0/166 (0.0) | 2/350 (0.6) | 0/132 (0.0) | 31/344 (9.0) | 11/182 (6.0) |
Recent hospitalization (< 3 months) | 26/401 (6.5) | 18/165 (10.9) | 41/348 (11.8) | 31/131 (23.7) | 90/342 (26.3) | 58/182 (31.9) |
Recent antibiotic treatment (< 3 months) | 50/402 (12.4) | 24/165 (14.5) | 56/347 (16.1) | 39/130 (30.0) | 56/342 (16.4) | 47/182 (25.8) |
Causes for ICU admission | ||||||
Shock | 58/394 (14.7) | 44/163 (27.0) | 144/343 (42.0) | 66/127 (52.0) | 147/336 (43.8) | 97/179 (54.2) |
Acute respiratory failure | 371/401 (92.5) | 150/166 (90.4) | 316/349 (90.5) | 117/131 (89.3) | 196/334 (58.7) | 83/179 (46.4) |
ARDS | 271/398 (68.1) | 115/165 (69.7) | 157/342 (45.9) | 63/127 (49.6) | 44/330 (13.3) | 28/179 (15.6) |
Neurological failure | 13/385 (3.4) | 13/163 (8.0) | 51/339 (15.0) | 18/126 (14.3) | 128/331 (38.7) | 63/178 (35.4) |
Cardiac arrest | 1/384 (0.3) | 2/163 (1.2) | 14/338 (4.1) | 11/127 (8.7) | 40/329 (12.2) | 44/179 (24.6) |
Acute kidney injury | 48/385 (12.5) | 48/163 (29.4) | 84/337 (24.9) | 49/124 (39.5) | 87/327 (26.6) | 49/178 (27.5) |
Results
Patient characteristics
SARS-CoV-2 pneumonia | Influenza pneumonia | No viral infection | ||||
---|---|---|---|---|---|---|
Alive (n = 402) | Dead (n = 166) | Alive (n = 350) | Dead (n = 132) | Alive (n = 344) | Dead (n = 182) | |
Antiviral treatment | 226/401 (56.4) | 96/165 (58.2) | 319/349 (91.4) | 118/132 (89.4) | 19/343 (5.5) | 5/180 (2.8) |
Oseltamivir | 30/399 (7.5) | 14/164 (8.5) | 314/344 (91.3) | 116/131 (88.5) | 18/342 (5.3) | 4/179 (2.2) |
Remdesivir | 21/399 (5.3) | 6/164 (3.7) | 0/344 (0.0) | 0/131 (0.0) | 0/342 (0.0) | 0/179 (0.0) |
Lopinavir-Ritonavir | 96/399 (24.1) | 51/164 (31.1) | 0/344 (0.0) | 0/131 (0.0) | 0/342 (0.0) | 0/179 (0.0) |
Lopinavir-Ritonavir + interferon | 12/399 (3.0) | 9/164 (5.5) | 0/344 (0.0) | 0/131 (0.0) | 0/342 (0.0) | 0/179 (0.0) |
Hydroxychloroquine | 134/399 (33.6) | 39/164 (23.8) | 0/344 (0.0) | 1/131 (0.8) | 0/342 (0.0) | 0/179 (0.0) |
Corticosteroids | 131/380 (34.5) | 71/162 (43.8) | 124/345 (35.9) | 58/130 (44.6) | 97/343 (28.3) | 64/182 (35.2) |
Hydrocortisone | 27/377 (7.2) | 32/160 (20.0) | 64/343 (18.7) | 43/130 (33.1) | 39/340 (11.5) | 41/180 (22.8) |
Dexamethasone | 32/377 (8.5) | 16/160 (10.0) | 1/343 (0.3) | 0/130 (0.0) | 6/340 (1.8) | 4/180 (2.2) |
Methylprednisolone | 70/377 (18.6) | 21/160 (13.1) | 58/343 (16.9) | 15/130 (11.5) | 51/340 (15.0) | 17/180 (9.4) |
Highest daily dose, mga | 100 (67–133) | 71 (50–133) | 75 (50–100) | 50 (50–100) | 63 (50–100) | 50 (50–75) |
Duration, daysb | 6 (4–9) | 6 (4–8) | 5 (3–9) | 6 (3–9) | 4 (2–7) | 4 (3–8) |
Antibiotic treatment | 363/378 (96.0) | 143/153 (93.5) | 309/330 (93.6) | 125/128 (97.7) | 268/323 (83.0) | 147/173 (85.0) |
Duration, days | 7 (5–9) | 7 (4–10) | 7 (5–11) | 7 (4–9) | 7 (4–9) | 6 (4–9) |
Prone positioning | 263/401 (65.6) | 120/166 (72.3) | 96/349 (27.5) | 55/132 (41.7) | 33/340 (9.7) | 30/182 (16.5) |
ECMO | 39/402 (9.7) | 22/165 (13.3) | 38/349 (10.9) | 22/131 (16.8) | 2/341 (0.6) | 3/182 (1.6) |
Characteristics of patients with ventilator-associated pneumonia
SARS-CoV-2 pneumonia (n = 205) | Influenza pneumonia (n = 107) | No viral infection (n = 87) | |
---|---|---|---|
Gram-positive cocci | |||
MSSA | 20 (9.8) | 5 (4.7) | 8 (9.2) |
MRSA | 6 (2.9) | 4 (3.7) | 2 (2.3) |
Enterococcus spp. | 7 (3.4) | 2 (1.9) | 2 (2.3) |
Streptococcus pneumoniae | 7 (3.4) | 1 (1) | 2 (2.3) |
Streptococcus spp. | 1 (0.5) | 0 (0) | 0 (0) |
Other | 0 (0) | 2 (1.9) | 3 (3.5) |
Gram-negative bacilli | |||
Pseudomonas aeruginosa | 51 (24.9) | 26 (24.3) | 15 (17.2) |
Enterobacter spp. | 37 (18) | 15 (14) | 12 (13.8) |
Klebsiella spp. | 26 (12.7) | 17 (15.9) | 12 (13.8) |
Escherichia coli | 19 (9.2) | 8 (7.5) | 5 (5.7) |
Acinetobacter baumannii | 9 (4.4) | 16 (15) | 10 (11.5) |
Stenotrophomonas maltophilia | 4 (2) | 2 (1.9) | 4 (4.6) |
Serratia marcescens | 9 (4.4) | 4 (3.7) | 1 (1.1) |
Citrobacter freundii | 6 (2.9) | 1 (1) | 1 (1.1) |
Citrobacter spp. | 5 (2.4) | 3 (2.8) | 3 (3.5) |
Proteus mirabilis | 5 (2.4) | 1 (1) | 2 (2.3) |
Haemophilus influenza | 3 (1.5) | 5 (4.7) | 5 (5.7) |
Morganella morganii | 2 (1) | 3 (2.8) | 0 (0) |
Other | 26 (12.7) | 8 (7.5) | 5 (5.7) |
Polymicrobial | 24 (11.7) | 8 (7.5) | 6 (6.9) |
Multidrug-resistant isolates* | 42 (20.7) | 42 (40) | 27 (31) |