Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

• Published in: Scientific reports Vol. 10; no. 1; p. 12702
• Main Authors: Fang, Wen-Feng, Fang, Ying-Tang, Huang, Chi-Han, Chen, Yu-Mu, Chang, Ya-Chun, Lin, Chiung-Yu, Hung, Kai-Yin, Chang, Ya-Ting, Chen, Hung-Cheng, Huang, Kuo-Tung, Chang, Huang-Chih, Chen, Yun-Che, Wang, Yi-Hsi, Wang, Chin-Chou, Lin, Meng-Chih
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 29.07.2020; Nature Publishing Group
• Subjects: 631/250/127; 692/53/2423; Aged; Aged, 80 and over; Female; Histocompatibility antigen HLA; HLA-D Antigens - metabolism; Hospitals; Humanities and Social Sciences; Humans; Immune response; Intensive care; Intensive Care Units; Interleukin 10; Interleukin-10 - metabolism; Intubation; Length of Stay; Male; Middle Aged; Mortality; multidisciplinary; Prognosis; Regression analysis; Respiration, Artificial - instrumentation; Retrospective Studies; Risk Factors; Science; Science (multidisciplinary); Sepsis; Sepsis - immunology; Sepsis - therapy; Survival Analysis; Ventilators; Ventilators, Mechanical - adverse effects
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-69731-3

We hypothesized that Ventilator-Associated Event (VAE) within 28 days upon admission to medical intensive care units (ICUs) can be a predictor for poor outcomes in sepsis patients. We aimed to determine the risk factors and associated outcomes of VAE. A total of 453 consecutive mechanically ventilated (MV) sepsis patients were enrolled. Of them, 136 patients had immune profile study. Early VAE (< 7-day MV, n = 33) was associated with a higher mortality (90 days: 81.8% vs. 23.0% [non-VAE], P < 0.01), while late VAE (developed between 7 and 28 days, n = 85) was associated with longer MV day (43.8 days vs. 23.3 days [non-VAE], P < 0.05). The 90-day Kaplan–Meier survival curves showed three lines that separate the groups (non-VAE, early VAE, and late VAE). Cox regression models with time-varying coefficient covariates (adjusted for the number of days from intubation to VAE development) confirmed that VAE which occurred within 28 days upon admission to the medical ICUs can be associated with higher 90-day mortality. The risk factors for VAE development include impaired immune response (lower human leukocyte antigen D-related expression, higher interleukin-10 expression) and sepsis progression with elevated SOFA score (especially in coagulation sub-score).