Background
Methods
Study design, patients
Data collection
Objectives and definition
Statistical analysis
Results
Number with missing data | Patients with BSI n = 780 | Patients without BSI n = 3230 | p-value | |
---|---|---|---|---|
Age, years | 0 | 62 [53–69] | 63 [54–71] | 0.019 |
Frailty scale | 395 | 2 [2, 3] | 2 [2, 3] | 0.80 |
Male gender | 23 | 607 (78) | 2346 (73) | 0.004 |
Body mass index, kg/m2 | 292 | 29 [26–33] | 28 [25–32] | 0.006 |
Living place | 69 | 3175 | 0.006 | |
Admission from a long-term care facility | 25 (3) | 48 (2) | ||
Admission from nursing home | 3 (0) | 29 (1) | ||
Admission from home | 738 (96) | 3098 (3) | ||
Severity on admission | ||||
SAPS II | 323 | 40 [30–54] | 36 [27–48] | < 0.001 |
SOFA score | 562 | 7 [4–9] | 4 [3–8] | < 0.001 |
ARDS severity on admission | 820 | < 0.001 | ||
No ARDS | 54 (7) | 365 (13) | ||
Mild ARDS | 146 (19) | 630 (22) | ||
Moderate ARDS | 343 (46) | 1292 (44) | ||
Severe ARDS | 190 (26) | 630 (22) | ||
Comorbidities | ||||
No comorbidities | 27 | 126 (16) | 588 (18) | 0.18 |
Alcohol consumption | 827 | 26 (4) | 134 (5) | 0.28 |
Tabaco consumption | 839 | 32 (5) | 135 (5) | 0.89 |
Chronic respiratory disease | 677 | 183 (28) | 671 (26) | 0.23 |
Chronic heart failure | 6 | 20 (3) | 131 (4) | 0.064 |
Hypertension | 4 | 379 (49) | 1523 (47) | 0.47 |
Coronary artery disease | 1 | 82 (11) | 348 (11) | 0.89 |
Diabetes mellitus | 2 | 231 (30) | 866 (27) | 0.12 |
Hematological malignancy | 0 | 22 (3) | 87 (3) | 0.94 |
Immunodepression | 773 | 62 (10) | 221 (9) | 0.45 |
Solid malignancy | 0 | 9 (1) | 50(2) | 0.51 |
Transplantation | 0 | 21 (3) | 62 (2) | 0.22 |
Chronic renal failure | 773 | 77 (24) | 301 (23) | 0.90 |
Cirrhosis | 668 | 3 (0) | 25 (1) | 0.32 |
Neuromuscular disease | 774 | 28 (4) | 69 (3) | 0.037 |
Home treatment | ||||
Long-term corticosteroids treatment | 1 | 36 (5) | 129 (4) | 0.49 |
Immunomodulatory drugs | 1 | 42 (5) | 125 (4) | 0.072 |
Treatment with NSAID | 536 | 58 (9) | 171 (6) | 0.022 |
Time from hospital admission to ICU, days | 153 | 1 [0–3] | 1 [0–3] | 0.49 |
Period of admission | 326 | 0.94 | ||
Before 15th of March 2020 | 46 (6) | 187 (6) | ||
From 15th March to 31th of March 2020 | 439 (61) | 1766 (60) | ||
From 1st April to 15 April 2020 | 193 (27) | 841 (28) | ||
After 15th of April 2020 | 40 (5) | 172 (5) | ||
Nurse/patient ratio | 713 | 2 [2, 3] | 2 [2, 3] | 0.61 |
Admission during night-hours* | 0 | 393 (50) | 1570 (48) | 0.39 |
Fever before admission | 146 | 634 (85) | 2567 (82) | 0.16 |
Abdominal symptoms before admission | 140 | 211 (27) | 901 (28) | 0.67 |
Co-infection at admission | 123 | 76 (10) | 247 (7.9) | 0.070 |
Bacterial co-infection | 66 (8) | 217 (7) | 0.10 | |
Viral co-infection | 4 (0) | 21 (0) | 0.86 | |
Hospital/ICU treatment | ||||
Antiviral treatment before admission | 13 | 384 (49) | 1451 (45) | 0.033 |
Immunomodulatory drugs | 12 (2) | 47 (1) | 0.99 | |
Tocilizumab use | 5 (1) | 26 (1) | 0.81 | |
Intubation before admission | 26 | 243 (31) | 629 (20) | < 0.001 |
Management during period at risk for BSI | ||||
Number of day at risk for BSI, days | 143 | 7 [3–11] | 12 [15–22] | < 0.001 |
ICU-acquired pneumonia during period at risk for BSI | 165 | 238 (31) | 1096 (34) | 0.075 |
Corticosteroids during period at risk for BSI | 21 | 171 (22) | 969 (30) | < 0.001 |
Renal replacement therapy during period at risk for BSI | 14 | 18 (2) | 569 (18) | < 0.001 |
ECMO support during period at risk for BSI | 14 | 68 (9) | 195 (6) | 0.009 |
Antibiotics use during period at risk for BSI | 7 | 618 (79) | 2871 (89) | < 0.001 |
Risk factors for BSI
Univariate analysis | Multivariable analysis | |||||
---|---|---|---|---|---|---|
sdHR | 95% CI | p-value | sdHR | 95% CI | p-value | |
Age, per supplementary year | 0.99 | 0.99–1.00 | 0.16 | 0.99 | 0.98–1.00 | 0.084 |
SAPS II score, per one point increment | 1.01 | 1.01–1.01 | < 0.001 | 1.01 | 1.00–1.02 | 0.046 |
SOFA at admission, per supplementary point | 1.05 | 1.03–1.07 | < 0.001 | 0.01 | 0.98–1.05 | 0.48 |
Mild ARDS | 0.93 | 0.78–1.11 | 0.41 | |||
Moderate ARDS | 1.06 | 0.93–1.23 | 0.38 | |||
Severe ARDS | 1.21 | 1.02–1.42 | 0.025 | 1.00 | 0.77–1.30 | 0.99 |
Frailty scale, per supplementary point | 0.98 | 0.92–1.05 | 0.61 | |||
Male | 1.23 | 1.04–1.46 | 0.013 | 1.41 | 1.08–1.84 | 0.011 |
BMI, per supplementary point | 1.01 | 1.00–1.02 | 0.017 | 1.01 | 0.99–1.03 | 0.13 |
No comorbidities | 0.99 | 0.83–1.19 | 0.96 | |||
Tabaco consumption | 0.94 | 0.65–1.35 | 0.72 | |||
Chronic respiratory disease | 1.2 | 1.01–1.42 | 0.037 | 1.01 | 0.79–1.28 | 0.96 |
Chronic heart failure | 0.81 | 0.55–1.19 | 0.27 | |||
Hypertension | 1.02 | 0.88–1.17 | 0.83 | |||
Coronary artery disease | 1.04 | 0.83–1.29 | 0.76 | |||
Diabetes mellitus | 1.06 | 0.91–1.24 | 0.44 | |||
Hematological malignancy | 1.32 | 0.90–1.94 | 0.16 | 1.50 | 0.86–2.63 | 0.15 |
Immunodepression | 1.02 | 0.78–1.34 | 0.89 | |||
Solid malignancy | 0.67 | 0.34–1.33 | 0.25 | |||
Solid organ transplantation | 1.08 | 0.67–1.75 | 0.74 | |||
Chronic renal failure | 0.89 | 0.74–1.07 | 0.23 | |||
Cirrhosis | 0.87 | 0.37–2.06 | 0.75 | |||
Neuromuscular disease | 1.5 | 1.02–2.21 | 0.042 | 1.29 | 0.73–2.30 | 0.38 |
Long-term corticosteroids treatment | 1.07 | 0.76–1.5 | 0.69 | |||
Immunomodulatory drugs | 1.12 | 0.80–1.56 | 0.52 | |||
Treatment with NSAID | 1.18 | 0.88–1.58 | 0.27 | |||
Admission from a long-term care facility | 1.99 | 1.32–3.02 | 0.001 | 2.78 | 0.80–9.55 | 0.11 |
Admission from nursing home | 0.61 | 0.23–1.59 | 0.31 | |||
Admission from Home | 0.75 | 0.55–1.03 | 0.072 | 2.34 | 0.93–5.85 | 0.070 |
Time from hospital admission to ICU, per supplementary day | 1.01 | 0.99–1.03 | 0.2 | 1.03 | 1.02–1.05 | < 0.001 |
Period of admission | ||||||
Before 15th of March 2020 | 0.94 | 0.70–1.28 | 0.71 | |||
From 15th March to 31th of March 2020 | 1.07 | 0.93–1.23 | 0.34 | |||
From 1st April to 15 April 2020 | 0.9 | 0.76–1.06 | 0.21 | |||
After 15th of April 2020 | 1.01 | 0.74–1.39 | 0.93 | |||
Nurse/patient ratio | 0.93 | 0.84–1.04 | 0.20 | 0.91 | 0.78–1.06 | 0.23 |
Admission during night hours* | 1.01 | 0.88–1.16 | 0.86 | |||
Fever before admission | 1.17 | 0.96–1.43 | 0.12 | 0.95 | 0.71–1.27 | 0.72 |
Abdominal symptoms before admission | 0.90 | 0.77–1.06 | 0.20 | 1.19 | 0.93–1.51 | 0.17 |
Co-infection at admission | 1.28 | 1.02–1.61 | 0.032 | 1.47 | 1.07–2.02 | 0.17 |
Bacterial co-infection | 1.25 | 0.97–1.59 | 0.08 | |||
Viral co-infection | 0.14 | 0.03–0.78 | 0.025 | |||
ICU acquired pneumonia during period at risk for BSI | 0.84 | 0.73–0.98 | 0.025 | |||
Antiviral treatment before admission | 1.12 | 0.98–1.29 | 0.11 | 1.41 | 1.11–1.79 | 0.005 |
Immunomodulatory drugs during period at risk for BSI | 1.14 | 0.66–1.97 | 0.64 | |||
Tocilizumab during period at risk for BSI | 0.8 | 0.33–1.92 | 0.62 | |||
Intubation during period at risk for BSI | 2.28 | 1.89–2.74 | < 0.001 | 5.18 | 3.45–7.77 | < 0.001 |
ECMO during period at risk for BSI | 1.21 | 0.94–1.55 | 0.15 | 1.26 | 0.82–1.93 | 0.30 |
Thrombosis during period at risk for BSI | 0.76 | 0.59–0.98 | 0.037 | 0.85 | 0.58–1.26 | 0.42 |
Renal replacement therapy during period at risk for BSI | 0.29 | 0.22–0.40 | < 0.001 | 0.30 | 0.18–0.49 | < 0.001 |
Antibiotic during period at risk for BSI | 0.52 | 0.43–0.62 | < 0.001 | 0.45 | 0.33–0.61 | < 0.001 |
Corticosteroids during period at risk for BSI | 0.74 | 0.63–0.87 | < 0.001 | 0.79 | 0.62–1.01 | 0.063 |
Number of day at risk for BSI, per supplementary days | 0.97 | 0.96–0.98 | < 0.001 | 0.93 | 0.92–0.95 | < 0.001 |
Risk factors for day-90 death
Univariate analysis | Multivariable analysis | |||||
---|---|---|---|---|---|---|
HR | 95% CI | p-value | HR | 95% CI | p-value | |
Age, per supplementary year | 1.04 | 1.03–1.05 | < 0.001 | 1.04 | 1.03–1.05 | < 0.001 |
Frailty scale | 1.37 | 1.31–1.42 | < 0.001 | 1.33 | 1.24–1.42 | < 0.001 |
Male | 1.11 | 0.98–1.26 | 0.096 | 1.15 | 0.95–1.39 | 0.16 |
BMI > 25 | 0.82 | 0.73–0.92 | < 0.001 | 0.83 | 0.69–1.01 | 0.056 |
SOFA at admission, per supplementary point | 1.10 | 1.09–1.12 | < 0.001 | 1.08 | 1.06–1.11 | < 0.001 |
ARDS severity at admission | ||||||
No ARDS | Ref | Ref | Ref | Ref | Ref | Ref |
Mild ARDS | 1.07 | 0.84–1.35 | 0.60 | 1.02 | 0.73–1.43 | 0.90 |
Moderate ARDS | 1.49 | 1.21–1.84 | < 0.001 | 1.09 | 0.80–1.47 | 0.59 |
Severe ARDS | 2.10 | 1.69–2.61 | < 0.001 | 1.87 | 1.37–2.57 | < 0.001 |
Comorbidities | ||||||
Alcohol consumption | 1.15 | 0.89–1.49 | 0.27 | |||
Tabaco consumption | 1.05 | 0.81–1.37 | 0.70 | |||
Chronic respiratory disease | 1.10 | 0.96–1.25 | 0.17 | 0.90 | 0.74–1.08 | 0.26 |
Chronic heart failure | 1.80 | 1.42–2.78 | < 0.001 | 1.38 | 0.98–1.94 | 0.063 |
Coronary artery disease | 1.78 | 1.54–2.06 | < 0.001 | 1.16 | 0.92–1.46 | 0.21 |
Diabetes mellitus | 1.51 | 1.35–1.69 | < 0.001 | 1.21 | 1.02–1.43 | 0.033 |
Hematological malignancy | 1.71 | 1.31–2.25 | < 0.001 | 0.99 | 0.66–1.49 | 0.97 |
Immunodepression | 1.44 | 1.20–1.73 | < 0.001 | 1.12 | 0.75–1.69 | 0.58 |
Solid malignancy | 1.95 | 1.36–2.78 | < 0.001 | 1.09 | 0.58–2.02 | 0.79 |
Solid organ transplantation | 1.98 | 1.48–2.66 | < 0.001 | 1.09 | 0.56–2.12 | 0.80 |
Chronic renal failure | 1.41 | 1.26–1.58 | < 0.001 | 1.05 | 0.82–1.34 | 0.70 |
Cirrhosis | 1.01 | 0.61–1.99 | 0.75 | |||
Neuromuscular disease | 0.94 | 0.66–1.32 | 0.71 | |||
Usual medication | ||||||
Long term corticosteroids treatment | 1.68 | 1.34–2.10 | < 0.001 | 1.00 | 0.63–1.58 | 0.99 |
Immunomodulatory drugs | 1.56 | 1.24–1.96 | < 0.001 | 1.04 | 0.62–1.74 | 0.90 |
Treatment with NSAID | 0.99 | 0.79–1.25 | 0.95 | |||
Time from hospital admission to ICU, per supplementary day | 1.00 | 0.99–1.01 | 0.92 | |||
Period of admission | ||||||
Before 15th of March | Ref | Ref | Ref | Ref | Ref | Ref |
From 15th March to 31th of March | 0.74 | 0.60–0.91 | 0.004 | 0.92 | 0.67–1.25 | 0.58 |
From 1st April to 15 April | 0.65 | 0.52–0.81 | < 0.001 | 0.86 | 0.61–1.21 | 0.39 |
After 15th of April | 0.50 | 0.35–0.68 | < 0.001 | 0.71 | 0.44–1.14 | 0.15 |
Nurse/patient ratio | 0.86 | 0.80–0.93 | < 0.001 | 0.89 | 0.80–0.99 | 0.037 |
Admission during night hours* | 0.98 | 0.88–1.09 | 0.68 | |||
Fever before admission | 0.84 | 0.73–0.96 | 0.013 | 0.85 | 0.69–1.04 | 0.11 |
Abdominal symptoms before admission | 0.81 | 0.71–0.91 | < 0.001 | 0.90 | 0.74–1.08 | 0.26 |
Co-infection at admission | 1.25 | 1.05–1.51 | 0.015 | 1.06 | 0.80–1.40 | 0.68 |
Bacterial co-infection | 1.28 | 1.06–1.55 | 0.012 | |||
Viral co-infection | 3.82 | 1.22–11.91 | 0.021 | |||
ICU acquired pneumonia during period at risk for BSI† | 1.10 | 0.98–1.23 | 0.093 | |||
Antiviral treatment before admission | 1.02 | 0.91–1.13 | 0.78 | |||
Immunomodulatory drugs before admission | 0.92 | 0.59–1.45 | 0.73 | |||
Tocilizumab before admission | 0.82 | 0.42–1.57 | 0.54 | |||
Intubation before admission | 1.32 | 1.17–1.49 | < 0.001 | 0.88 | 0.71–1.09 | 0.25 |
Number of day at risk for BSI, per supplementary days | 0.99 | 0.99–1.01 | 0.52 | |||
Bloodstream infection | 1.31 | 1.15–1.48 | < 0.001 | 1.28 | 1.05–1.56 | 0.015 |
Propensity score matched analysis
Patients with BSI n = 537 | Patients without BSI n = 537 | p-value | |
---|---|---|---|
Length of stay in ICU, days | 24 [15–36] | 13 [6–25] | < 0.001 |
Length of stay in hospital, days | 40 [27–58] | 24 [13–40] | < 0.001 |
ICU-free days at day 90, days | 52 [0–74] | 65 [0–81] | < 0.001 |
Ventilator-free days at day 90, days | 61 [0–81] | 70 [0–88] | < 0.001 |
Death at day 90 | 212 (39) | 178 (33) | 0.036 |