Influenza and associated co-infections in critically ill immunosuppressed patients

Ignacio Martin-Loeches, Virginie Lemiale, Pierce Geoghegan, Mary Aisling McMahon, Peter Pickkers, Marcio Soares, Anders Perner, Tine Sylvest Meyhoff, Ramin Brandt Bukan, Jordi Rello, Philippe R. Bauer, Andry Van De Louw, Fabio Silvio Taccone, Jorge Salluh, Pleun Hemelaar, Peter Schellongowski, Katerina Rusinova, Nicolas Terzi, Sangeeta Mehta, Massimo Antonelli & 20 others Achille Kouatchet, Pål Klepstad, Miia Valkonen, Precious Pearl Landburg, Andreas Barratt-Due, Fabrice Bruneel, Frédéric Pène, Victoria Metaxa, Anne Sophie Moreau, Virginie Souppart, Gaston Burghi, Christophe Girault, Ulysses V.A. Silva, Luca Montini, Francois Barbier, Lene B. Nielsen, Benjamin Gaborit, Djamel Mokart, Sylvie Chevret, Elie Azoulay

Research output: Contribution to journalArticle

Abstract

Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.

Original languageEnglish (US)
Article number152
JournalCritical Care
Volume23
Issue number1
DOIs
StatePublished - May 2 2019

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Coinfection
Critical Illness
Human Influenza
Hospital Mortality
Infection
Respiratory Insufficiency
Length of Stay
Propensity Score
Mortality
Intubation
Lung
Immunocompromised Host
Cohort Studies

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Martin-Loeches, I., Lemiale, V., Geoghegan, P., McMahon, M. A., Pickkers, P., Soares, M., ... Azoulay, E. (2019). Influenza and associated co-infections in critically ill immunosuppressed patients. Critical Care, 23(1), [152]. https://doi.org/10.1186/s13054-019-2425-6
Martin-Loeches, Ignacio ; Lemiale, Virginie ; Geoghegan, Pierce ; McMahon, Mary Aisling ; Pickkers, Peter ; Soares, Marcio ; Perner, Anders ; Meyhoff, Tine Sylvest ; Bukan, Ramin Brandt ; Rello, Jordi ; Bauer, Philippe R. ; Van De Louw, Andry ; Taccone, Fabio Silvio ; Salluh, Jorge ; Hemelaar, Pleun ; Schellongowski, Peter ; Rusinova, Katerina ; Terzi, Nicolas ; Mehta, Sangeeta ; Antonelli, Massimo ; Kouatchet, Achille ; Klepstad, Pål ; Valkonen, Miia ; Landburg, Precious Pearl ; Barratt-Due, Andreas ; Bruneel, Fabrice ; Pène, Frédéric ; Metaxa, Victoria ; Moreau, Anne Sophie ; Souppart, Virginie ; Burghi, Gaston ; Girault, Christophe ; Silva, Ulysses V.A. ; Montini, Luca ; Barbier, Francois ; Nielsen, Lene B. ; Gaborit, Benjamin ; Mokart, Djamel ; Chevret, Sylvie ; Azoulay, Elie. / Influenza and associated co-infections in critically ill immunosuppressed patients. In: Critical Care. 2019 ; Vol. 23, No. 1.
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abstract = "Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8{\%}), patients with influenza plus pulmonary co-infection (n = 58, 3.6{\%}), patients with non-influenza pulmonary infection (n = 820, 50.9{\%}), and patients without pulmonary infection (n = 638, 39.6{\%}). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41{\%} and 37{\%} respectively) that was higher than patients with influenza alone or those without infection (33{\%} and 26{\%} respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95{\%}CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.",
author = "Ignacio Martin-Loeches and Virginie Lemiale and Pierce Geoghegan and McMahon, {Mary Aisling} and Peter Pickkers and Marcio Soares and Anders Perner and Meyhoff, {Tine Sylvest} and Bukan, {Ramin Brandt} and Jordi Rello and Bauer, {Philippe R.} and {Van De Louw}, Andry and Taccone, {Fabio Silvio} and Jorge Salluh and Pleun Hemelaar and Peter Schellongowski and Katerina Rusinova and Nicolas Terzi and Sangeeta Mehta and Massimo Antonelli and Achille Kouatchet and P{\aa}l Klepstad and Miia Valkonen and Landburg, {Precious Pearl} and Andreas Barratt-Due and Fabrice Bruneel and Fr{\'e}d{\'e}ric P{\`e}ne and Victoria Metaxa and Moreau, {Anne Sophie} and Virginie Souppart and Gaston Burghi and Christophe Girault and Silva, {Ulysses V.A.} and Luca Montini and Francois Barbier and Nielsen, {Lene B.} and Benjamin Gaborit and Djamel Mokart and Sylvie Chevret and Elie Azoulay",
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doi = "10.1186/s13054-019-2425-6",
language = "English (US)",
volume = "23",
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Martin-Loeches, I, Lemiale, V, Geoghegan, P, McMahon, MA, Pickkers, P, Soares, M, Perner, A, Meyhoff, TS, Bukan, RB, Rello, J, Bauer, PR, Van De Louw, A, Taccone, FS, Salluh, J, Hemelaar, P, Schellongowski, P, Rusinova, K, Terzi, N, Mehta, S, Antonelli, M, Kouatchet, A, Klepstad, P, Valkonen, M, Landburg, PP, Barratt-Due, A, Bruneel, F, Pène, F, Metaxa, V, Moreau, AS, Souppart, V, Burghi, G, Girault, C, Silva, UVA, Montini, L, Barbier, F, Nielsen, LB, Gaborit, B, Mokart, D, Chevret, S & Azoulay, E 2019, 'Influenza and associated co-infections in critically ill immunosuppressed patients', Critical Care, vol. 23, no. 1, 152. https://doi.org/10.1186/s13054-019-2425-6

Influenza and associated co-infections in critically ill immunosuppressed patients. / Martin-Loeches, Ignacio; Lemiale, Virginie; Geoghegan, Pierce; McMahon, Mary Aisling; Pickkers, Peter; Soares, Marcio; Perner, Anders; Meyhoff, Tine Sylvest; Bukan, Ramin Brandt; Rello, Jordi; Bauer, Philippe R.; Van De Louw, Andry; Taccone, Fabio Silvio; Salluh, Jorge; Hemelaar, Pleun; Schellongowski, Peter; Rusinova, Katerina; Terzi, Nicolas; Mehta, Sangeeta; Antonelli, Massimo; Kouatchet, Achille; Klepstad, Pål; Valkonen, Miia; Landburg, Precious Pearl; Barratt-Due, Andreas; Bruneel, Fabrice; Pène, Frédéric; Metaxa, Victoria; Moreau, Anne Sophie; Souppart, Virginie; Burghi, Gaston; Girault, Christophe; Silva, Ulysses V.A.; Montini, Luca; Barbier, Francois; Nielsen, Lene B.; Gaborit, Benjamin; Mokart, Djamel; Chevret, Sylvie; Azoulay, Elie.

In: Critical Care, Vol. 23, No. 1, 152, 02.05.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Influenza and associated co-infections in critically ill immunosuppressed patients

AU - Martin-Loeches, Ignacio

AU - Lemiale, Virginie

AU - Geoghegan, Pierce

AU - McMahon, Mary Aisling

AU - Pickkers, Peter

AU - Soares, Marcio

AU - Perner, Anders

AU - Meyhoff, Tine Sylvest

AU - Bukan, Ramin Brandt

AU - Rello, Jordi

AU - Bauer, Philippe R.

AU - Van De Louw, Andry

AU - Taccone, Fabio Silvio

AU - Salluh, Jorge

AU - Hemelaar, Pleun

AU - Schellongowski, Peter

AU - Rusinova, Katerina

AU - Terzi, Nicolas

AU - Mehta, Sangeeta

AU - Antonelli, Massimo

AU - Kouatchet, Achille

AU - Klepstad, Pål

AU - Valkonen, Miia

AU - Landburg, Precious Pearl

AU - Barratt-Due, Andreas

AU - Bruneel, Fabrice

AU - Pène, Frédéric

AU - Metaxa, Victoria

AU - Moreau, Anne Sophie

AU - Souppart, Virginie

AU - Burghi, Gaston

AU - Girault, Christophe

AU - Silva, Ulysses V.A.

AU - Montini, Luca

AU - Barbier, Francois

AU - Nielsen, Lene B.

AU - Gaborit, Benjamin

AU - Mokart, Djamel

AU - Chevret, Sylvie

AU - Azoulay, Elie

PY - 2019/5/2

Y1 - 2019/5/2

N2 - Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.

AB - Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.

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U2 - 10.1186/s13054-019-2425-6

DO - 10.1186/s13054-019-2425-6

M3 - Article

VL - 23

JO - Critical Care

JF - Critical Care

SN - 1364-8535

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ER -

Martin-Loeches I, Lemiale V, Geoghegan P, McMahon MA, Pickkers P, Soares M et al. Influenza and associated co-infections in critically ill immunosuppressed patients. Critical Care. 2019 May 2;23(1). 152. https://doi.org/10.1186/s13054-019-2425-6