Background
Methods
Study design and settings
Study population
Definitions
Outcomes
Data source
Data collection
Statistical analysis and bias control
Results
Epidemiology of N-CLABSI in ICU patients
Comparisons of patients with N-CLABSI versus without N-CLABSI or with CLABSI
Features | Patients with N-CLABSI (n = 155) (group A) | Patients without N-CLABSI (n = 4891) (group B*) | Patients with CLABSI (n = 64) (group B-sub) | p value† | |
---|---|---|---|---|---|
A vs. B | A vs. B-sub | ||||
Age (years), mean ± SD | 53.3 ± 16.4 | 56.9 ± 17.7 | 58.4 ± 16.0 |
0.012
|
0.039
|
Sex, no. male (%) | 110 (71.0) | 3174 (64.9) | 43 (70.5) | 0.118 | 0.945 |
APACHE II score on ICU admission, mean ± SD | 21.0 ± 8.0 | 19.0 ± 8.1 | 22.4 ± 8.5 |
0.002
| 0.272 |
Chronic underlying diseases, no. (%) | 107 (69.0) | 3342 (68.3) | 51 (83.6) | 0.853 |
0.030
|
Diabetes, no. (%) | 30 (19.4) | 619 (12.7) | 18 (29.5) | ||
Hypertension, no. (%) | 35 (22.6) | 1028 (21.0) | 21 (34.4) | ||
Respiratory diseases, no. (%) | 16 (10.3) | 654 (13.4) | 7 (11.5) | ||
Cardiovascular diseases, no. (%) | 27 (17.4) | 744 (15.2) | 15 (24.6) | ||
Renal diseases, no. (%) | 23 (14.8) | 609 (12.5) | 12 (19.7) | ||
Liver diseases, no. (%) | 52 (33.5) | 1147 (23.5) | 26 (42.6) | ||
Malignancies, no. (%) | 18 (11.6) | 1138 (23.3) | 10 (16.4) | ||
Disorder of consciousness, no. (%) | 21 (13.5) | 479 (9.8) | 10 (16.4) | 0.123 | 0.591 |
Gastrointestinal bleeding, no. (%) | 25 (16.1) | 395 (8.1) | 9 (14.8) |
< 0.001
| 0.803 |
Trauma, no. (%) | 30 (19.4) | 720 (14.7) | 6 (9.8) | 0.110 | 0.091 |
Immunological diseases, no. (%) | 18 (11.6) | 767 (15.7) | 11 (18.0) | 0.169 | 0.213 |
Organ transplantation, no. (%) | 15 (9.7) | 536 (11.0) | 8 (13.1) | 0.615 | 0.461 |
Multiple organ failure, no. (%) | 62 (40.0) | 1150 (23.5) | 24 (39.3) |
< 0.001
| 0.929 |
Shock, no. (%) | 69 (44.5) | 1118 (22.9) | 25 (41.0) |
< 0.001
| 0.637 |
Pancreatitis, no. (%) | 70 (45.2) | 597 (12.2) | 30 (32.8) |
< 0.001
| 0.097 |
ARDS, no. (%) | 26 (16.8) | 225 (4.6) | 6 (9.8) |
< 0.001
| 0.196 |
Surgical operation, no. (%) | 120 (77.4) | 3024 (61.8) | 44 (72.1) |
< 0.001
| 0.413 |
Intravascular catheters, no. (%) | 140 (90.3) | 2962 (60.6) | 61 (100.0) |
< 0.001
|
0.012
|
Organ biopsy, no. (%) | 31 (3.7) | 812 (16.6) | 17 (27.9) | 0.264 | 0.210 |
MV, no. (%) | 141 (91.0) | 4386 (89.7) | 56 (91.8) | 0.602 | 0.845 |
UC, no. (%) | 148 (95.5) | 4690 (95.9) | 57 (93.4) | 0.152 | 0.539 |
MDRO, no. (%) | 67 (43.2) | 1660 (33.9) | 41 (67.2) |
0.017
|
0.002
|
Sepsis, no. (%) | 38 (24.5) | 332 (6.8) | 11 (18.0) |
< 0.001
| 0.306 |
Pneumonia, no. (%) | 108 (69.7) | 2648 (54.1) | 45 (73.8) |
< 0.001
| 0.551 |
IAI, no. (%) | 87 (56.1) | 371 (7.6) | 7 (11.5) |
< 0.001
|
< 0.001
|
HAIs other than NBSIs, pneumonia and IAI, no. (%) | 17 (11.0) | 161 (3.3) | 5 (8.2) |
< 0.001
| 0.544 |
Days prior to NBSI date from ICU admission, median (IQR) | 13.0 (8.0–25.0) | NA | 19.0 (12.5–30.0) | NA |
0.031
|
Outcomes | |||||
LOS in ICU after NBSI date (days), median (IQR) | 15.0 (8.0–27.0) | NA | 16.0 (6.0–30.0) | NA | 0.876 |
LOS in hospital after NBSI date (days), median (IQR) | 18.0 (8.0–37.0) | NA | 19.0 (9.5–36.5) | NA | 0.729 |
LOS in ICU (days), median (IQR) | 32.0 (18.0–55.0) | 10.0 (5.0–18.0) | 34.0 (20.0–59.5) |
< 0.001
| 0.308 |
LOS in hospital (days), median (IQR) | 42.0 (24.0–68.0) | 21.0 (13.0–33.0) | 39.0 (26.0–77.5) |
< 0.001
| 0.533 |
Hospitalization costs (CNY), median (IQR) | 305,074 (196,575–452,309) | 97,591 (57,306–190,754) | 35,9646 (229,092–549,737) |
< 0.001
| 0.103 |
Deaths in ICU (mortality) | 39 (25.2) | 637 (13.0) | 20 (32.8) |
< 0.001
| 0.258 |
Predicted deaths in ICU (predicted mortality) | 90 (58.1) | 1343 (27.5) | 35 (57.4) |
< 0.001
| 0.927 |
Impacts of N-CLABSI on the outcomes
Outcomes | Matching ratio | With N-CLABSI | Without N-CLABSI | Excess values | p value* |
---|---|---|---|---|---|
LOS in ICU (days), median (IQR) | 155:518 | 32.0 (18.0–55.0) | 17.0 (9.0–31.0) | 15.0 |
< 0.001
|
LOS in hospital (days), median (IQR) | 155:518 | 42.0 (24.0–68.0) | 29.0 (16.0–48.0) | 13.0 |
< 0.001
|
Hospitalization costs (CNY), median (IQR) | 155:525 | 305,074 (196,575–452,309) | 118,317 (68,819–220,763) | 186,757 |
< 0.001
|
Deaths in ICU (mortality) | 153:487 | 38 (24.8%) | 78 (16.0%) | 8.8% |
0.013
|
Predicted deaths in ICU (predicted mortality) | 153:487 | 89 (58.2%) | 173 (35.5%) | 22.7% |
< 0.001
|
Outcomes | Adjusted β* or OR† | 95% CI | p value‡ |
---|---|---|---|
Logarithmic value of LOS in ICU | β = 0.217 | 0.156–0.277 |
< 0.001
|
Logarithmic value of LOS in hospital | β = 0.137 | 0.076–0.197 |
< 0.001
|
Logarithmic value of hospitalization costs | β = 0.213 | 0.152–0.275 |
< 0.001
|
Death in ICU | OR = 2.175 | 1.294–3.656 |
0.003
|
Predicted death in ICU | OR = 2.960 | 1.850–4.737 |
0.001
|
Risk factors for N-CLABSI in ICU patients
Variables* | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
OR (95% CI) | p value† | Adjusted OR (95% CI) | p value‡ | |
Age (years)
|
0.988 (0.980–0.997)
|
0.012
| 1.004 (0.993–1.016) | 0.431 |
Sex (male) | 1.322 (0.930–1.880) | 0.120 | ||
APACHE II score on ICU admission
|
1.032 (1.010–1.050)
|
0.002
| 1.010 (0.986–1.034) | 0.411 |
Chronic underlying diseases | 1.033 (0.731–1.460) | 0.853 | ||
Disorder of consciousness | 1.443 (0.903–2.309) | 0.125 | ||
Gastrointestinal bleeding
|
2.189 (1.409–3.399)
|
< 0.001
|
2.295 (1.377–3.824)
|
0.001
|
Trauma
| 1.390 (0.926–2.087) | 0.112 |
2.521 (1.573–4.040)
|
< 0.001
|
Immunological diseases | 0.706 (0.430–1.160) | 0.171 | ||
Organ transplantation | 0.871 (0.507–1.494) | 0.615 | ||
Multiple organ failure
|
2.169 (1.562–3.011)
|
< 0.001
| 1.093 (0.734–1.627) | 0.663 |
Shock
|
2.708 (1.959–3.743)
|
< 0.001
| 1.005 (0.683–1.479) | 0.979 |
Pancreatitis
|
5.923 (4.268–8.220)
|
< 0.001
|
3.445 (2.239–5.300)
|
< 0.001
|
ARDS
|
4.180 (2.686–6.503)
|
< 0.001
| 1.673 (0.982–2.850) | 0.058 |
Surgical operation
|
2.117 (1.446–3.098)
|
< 0.001
|
1.815 (1.186–2.776)
|
0.006
|
Intravascular catheters
|
6.078 (3.558–10.384)
|
< 0.001
|
2.934 (1.649–5.221)
|
< 0.001
|
Organ biopsy | 1.256 (0.841–1.875) | 0.265 | ||
MV | 1.160 (0.664–2.024) | 0.602 | ||
UC | 0.621 (0.322–1.198) | 0.155 | ||
MDRO positive
|
1.481 (1.072–2.046)
|
0.017
| 0.732 (0.500–1.069) | 0.107 |
Sepsis
|
4.460 (3.042–6.538)
|
< 0.001
|
1.693 (1.088–2.633)
|
0.020
|
Pneumonia
|
1.946 (1.376–2.754)
|
< 0.001
|
1.528 (1.025–2.277)
|
0.038
|
IAI
|
15.185 (10.873–21.206)
|
< 0.001
|
8.369 (5.630–12.440)
|
< 0.001
|
HAIs other than NBSI, pneumonia and IAI
|
3.619 (2.135–6.135)
|
< 0.001
|
3.888 (2.087–7.244)
|
< 0.001
|