Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Andrea Cortegiani, Fabiana Madotto, Cesare Gregoretti, Giacomo Bellani, John G. Laffey, Tai Pham, Frank Van Haren, Antonino Giarratano, Massimo Antonelli, Antonio Pesenti, Giacomo Grasselli, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina S. Insaurralde, Risso V. Alejandro, Julio Daldin, Mauricio VinzioRuben O. Fernandez, Luis P. Cardonnet, Lisandro R. Bettini, Mariano Carboni Bisso, Emilio M. Osman, Mariano G. Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Norberto C. Pozo, Nicolas Grubissich, Gustavo A. Plotnikow, Daniela N. Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A. Pellegrini, María G. Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo E. Gomez, Alessandro Protti, Giovanna Panarello, Giovanna Occhipinti, Giacomo Monti, Francesco Mojoli, Antonio Braschi, Giorgio A. Iotti, Aaron Venti

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.

Original languageEnglish
Article number157
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Jun 12 2018

Fingerprint

Adult Respiratory Distress Syndrome
Immunocompromised Host
Databases
Noninvasive Ventilation
Mortality
Hospital Mortality
Respiratory Insufficiency
Immunosuppression
Observational Studies
Ventilation
Shock
Sepsis
Pneumonia
Epidemiology
Cohort Studies
Prospective Studies
Infection

Keywords

  • Acute respiratory failure
  • ARDS
  • Immunocompromised patients
  • Mechanical ventilation
  • Noninvasive ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database. / Cortegiani, Andrea; Madotto, Fabiana; Gregoretti, Cesare; Bellani, Giacomo; Laffey, John G.; Pham, Tai; Van Haren, Frank; Giarratano, Antonino; Antonelli, Massimo; Pesenti, Antonio; Grasselli, Giacomo; Sula, Hektor; Nunci, Lordian; Cani, Alma; Zazu, Alan; Dellera, Christian; Insaurralde, Carolina S.; Alejandro, Risso V.; Daldin, Julio; Vinzio, Mauricio; Fernandez, Ruben O.; Cardonnet, Luis P.; Bettini, Lisandro R.; Bisso, Mariano Carboni; Osman, Emilio M.; Setten, Mariano G.; Lovazzano, Pablo; Alvarez, Javier; Villar, Veronica; Pozo, Norberto C.; Grubissich, Nicolas; Plotnikow, Gustavo A.; Vasquez, Daniela N.; Ilutovich, Santiago; Tiribelli, Norberto; Chena, Ariel; Pellegrini, Carlos A.; Saenz, María G.; Estenssoro, Elisa; Brizuela, Matias; Gianinetto, Hernan; Gomez, Pablo E.; Protti, Alessandro; Panarello, Giovanna; Occhipinti, Giovanna; Monti, Giacomo; Mojoli, Francesco; Braschi, Antonio; Iotti, Giorgio A.; Venti, Aaron.

In: Critical Care, Vol. 22, No. 1, 157, 12.06.2018.

Research output: Contribution to journalArticle

Cortegiani, A, Madotto, F, Gregoretti, C, Bellani, G, Laffey, JG, Pham, T, Van Haren, F, Giarratano, A, Antonelli, M, Pesenti, A, Grasselli, G, Sula, H, Nunci, L, Cani, A, Zazu, A, Dellera, C, Insaurralde, CS, Alejandro, RV, Daldin, J, Vinzio, M, Fernandez, RO, Cardonnet, LP, Bettini, LR, Bisso, MC, Osman, EM, Setten, MG, Lovazzano, P, Alvarez, J, Villar, V, Pozo, NC, Grubissich, N, Plotnikow, GA, Vasquez, DN, Ilutovich, S, Tiribelli, N, Chena, A, Pellegrini, CA, Saenz, MG, Estenssoro, E, Brizuela, M, Gianinetto, H, Gomez, PE, Protti, A, Panarello, G, Occhipinti, G, Monti, G, Mojoli, F, Braschi, A, Iotti, GA & Venti, A 2018, 'Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database', Critical Care, vol. 22, no. 1, 157. https://doi.org/10.1186/s13054-018-2079-9
Cortegiani, Andrea ; Madotto, Fabiana ; Gregoretti, Cesare ; Bellani, Giacomo ; Laffey, John G. ; Pham, Tai ; Van Haren, Frank ; Giarratano, Antonino ; Antonelli, Massimo ; Pesenti, Antonio ; Grasselli, Giacomo ; Sula, Hektor ; Nunci, Lordian ; Cani, Alma ; Zazu, Alan ; Dellera, Christian ; Insaurralde, Carolina S. ; Alejandro, Risso V. ; Daldin, Julio ; Vinzio, Mauricio ; Fernandez, Ruben O. ; Cardonnet, Luis P. ; Bettini, Lisandro R. ; Bisso, Mariano Carboni ; Osman, Emilio M. ; Setten, Mariano G. ; Lovazzano, Pablo ; Alvarez, Javier ; Villar, Veronica ; Pozo, Norberto C. ; Grubissich, Nicolas ; Plotnikow, Gustavo A. ; Vasquez, Daniela N. ; Ilutovich, Santiago ; Tiribelli, Norberto ; Chena, Ariel ; Pellegrini, Carlos A. ; Saenz, María G. ; Estenssoro, Elisa ; Brizuela, Matias ; Gianinetto, Hernan ; Gomez, Pablo E. ; Protti, Alessandro ; Panarello, Giovanna ; Occhipinti, Giovanna ; Monti, Giacomo ; Mojoli, Francesco ; Braschi, Antonio ; Iotti, Giorgio A. ; Venti, Aaron. / Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database. In: Critical Care. 2018 ; Vol. 22, No. 1.
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abstract = "Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8{\%}) were immunocompromised, 38.9{\%} of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4{\%} vs 36.2{\%}; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1{\%} vs 18.6{\%}; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9{\%} vs 15.9{\%}; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.",
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TY - JOUR

T1 - Immunocompromised patients with acute respiratory distress syndrome

T2 - Secondary analysis of the LUNG SAFE database

AU - Cortegiani, Andrea

AU - Madotto, Fabiana

AU - Gregoretti, Cesare

AU - Bellani, Giacomo

AU - Laffey, John G.

AU - Pham, Tai

AU - Van Haren, Frank

AU - Giarratano, Antonino

AU - Antonelli, Massimo

AU - Pesenti, Antonio

AU - Grasselli, Giacomo

AU - Sula, Hektor

AU - Nunci, Lordian

AU - Cani, Alma

AU - Zazu, Alan

AU - Dellera, Christian

AU - Insaurralde, Carolina S.

AU - Alejandro, Risso V.

AU - Daldin, Julio

AU - Vinzio, Mauricio

AU - Fernandez, Ruben O.

AU - Cardonnet, Luis P.

AU - Bettini, Lisandro R.

AU - Bisso, Mariano Carboni

AU - Osman, Emilio M.

AU - Setten, Mariano G.

AU - Lovazzano, Pablo

AU - Alvarez, Javier

AU - Villar, Veronica

AU - Pozo, Norberto C.

AU - Grubissich, Nicolas

AU - Plotnikow, Gustavo A.

AU - Vasquez, Daniela N.

AU - Ilutovich, Santiago

AU - Tiribelli, Norberto

AU - Chena, Ariel

AU - Pellegrini, Carlos A.

AU - Saenz, María G.

AU - Estenssoro, Elisa

AU - Brizuela, Matias

AU - Gianinetto, Hernan

AU - Gomez, Pablo E.

AU - Protti, Alessandro

AU - Panarello, Giovanna

AU - Occhipinti, Giovanna

AU - Monti, Giacomo

AU - Mojoli, Francesco

AU - Braschi, Antonio

AU - Iotti, Giorgio A.

AU - Venti, Aaron

PY - 2018/6/12

Y1 - 2018/6/12

N2 - Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.

AB - Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013.

KW - Acute respiratory failure

KW - ARDS

KW - Immunocompromised patients

KW - Mechanical ventilation

KW - Noninvasive ventilation

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