Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Abstract

Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox’s regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16–2.47), p = 0.006), and influenza groups (1.75 (1.03–3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64–1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.

Timing and causes of death in severe COVID-19 patients

“…Once again, the in-hospital course of COVID-19 patients admitted to the ICU is different, with a low reported rate of bacterial co-infection at admission as compared to other causes of viral pneumonitis [ 23 ]. However, recent studies have reported that patients with SARS-CoV-2 infection are at higher risk for ICU-acquired pneumonia [ 24 , 25 ] as compared with other causes of pneumonitis, with some data suggesting a significant association between increased mortality and ICU-acquired pneumonia in severe COVID-19 patients [ 25 ]. However, precise evaluation of the attributable mortality, defined as the percentage of deaths that would not have occurred without infection, is complex for ICU-acquired pneumonia and requires the use of competing risk statistical models.…”

Correction to: Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

“…Following publication of the original article [ 1 ], the authors identified an error in the Abstract and Results section. The correct numbers and text are given hereafter.…”

“…All the changes that were requested are implemented in this correction and the original article [ 1 ] has been corrected.…”

Ventilator-Associated Pneumonia in COVID-19 Patients: A Retrospective Cohort Study

“…The main factors associated with mortality during VAP are septic shock and severe acute respiratory syndrome (ARDS). However, features and specific risk factors of VAP in COVID-19 patients have not yet been established [ 13 ].…”