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Predictive Factors for Pneumonia Onset After Cardiac Surgery in Rio de Janeiro, Brazil

Published online by Cambridge University Press:  02 January 2015

Marisa Santos ,
José Ueleres Braga ,
Renato Vieira Gomes  and
Guilherme L. Werneck
Marisa Santos
Affiliation:
Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil National Institute of Cardiologyand Pró-Cardiaco Hospital/PROCEP, Rio de Janeiro, Brazil
José Ueleres Braga
Affiliation:
Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
Renato Vieira Gomes
Affiliation:
National Institute of Cardiologyand Pró-Cardiaco Hospital/PROCEP, Rio de Janeiro, Brazil
Guilherme L. Werneck*
Affiliation:
Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
*
Dsc, Institute de Medicina Social/IMS, Departamento de Epidemiologia, Universidade do Estado do Rio de Janeiro (UERJ), Rua São Francisco Xavier 524, 7° andar, Bloco D, Maracanã, Rio de Janeiro, RJ, Brazil, 20559-900 (gwerneck@nesc.ufrj.br).
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Abstract

Objective.

To develop a predictive system for the occurrence of nosocomial pneumonia in patients who had cardiac surgery performed.

Design.

Retrospective cohort study.

Setting.

Two cardiologic tertiary care hospitals in Rio de Janeiro, Brazil.

Patients.

Between June 2000 and August 2002, there were 1,158 consecutive patients who had complex heart surgery performed. Patients older than 18 years who survived the first 48 postoperative hours were included in the study. The occurrence of pneumonia was diagnosed through active surveillance by an infectious diseases specialist according to the following criteria: the presence of new infiltrate on a radiograph in association with purulent sputum and either fever or leukocytosis until day 10 after cardiac surgery. Predictive models were built on the basis of logistic regression analysis and classification and regression tree (CART) analysis. The original data set was divided randomly into 2 parts, one used to construct the models (ie, “test sample”) and the other used for validation (ie, “validation sample”).

Results.

The area under the receiver–operating characteristic (ROC) curve was 69% for the logistic regression model and 76% for the CART model. Considering a probability greater than 7% to be predictive of pneumonia for both models, sensitivity was higher for the logistic regression models, compared with the CART models (64% vs 56%). However, the CART models had a higher specificity (92% vs 70%) and global accuracy (90% vs 70%) than the logistic regression models. Both models showed good performance, based on the 2-graph ROC, considering that 84.6% and 84.3% of the predictions obtained by regression and CART analyses were regarded as valid.

Conclusion.

Although our findings are preliminary, the predictive models we created showed fairly good specificity and fair sensitivity.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 4 , April 2007 , pp. 382 - 388
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Asensio, A, Torres, J. Proportion of mortality caused by severe hospital-acquired infection in open-heart surgery. Clin Perform Qual Health Care 1996;4:67–73.Google ScholarPubMed
2.Rebollo, MH, Bernal, JM, Llorca, J, Rabasa, JM, Revuelta, JM. Nosocomial infections in patients having cardiovascular operations: a multivariate analysis of risk factors. J Thorac Cardiovasc Surg 1996;112:908–913.CrossRefGoogle ScholarPubMed
3.Rello, J, Paiva, JA, Baraibar, J, et al.International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-Associated Pneumonia. Chest 2001;120:955–970.CrossRefGoogle ScholarPubMed
4.Miholic, J, Hudec, M, Domanig, E, et al.Risk factors for severe bacterial infections after valve replacement and aortocoronary bypass operations: analysis of 246 cases by logistic regression. Ann Thorac Surg 1985;40:224–228.CrossRefGoogle ScholarPubMed
5.Gaynes, R, Bizek, B, Mowry-Hanley, J, Kirsh, M. Risk factors for nosocomial pneumonia after coronary artery bypass graft operations. Ann Thorac Surg 1991;51:215–218.CrossRefGoogle ScholarPubMed
6.Leal-Noval, SR, Marquez-Vacaro, JA, Garcia-Curiel, A, et al.Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Med 2000;28:935–940.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. Guidelines for Preventing Health-Care-Associated Pneumonia, 2003. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. Available at: http://www.cdc.gov/ncidod/hip/guide/dhqp/gl_hcpneumonia.html. Accessed August 16, 2005.Google Scholar
8.Collard, HR, Saint, S, Matthay, MA. Prevention of ventilator-associated pneumonia: an evidence-based systematic review. Ann Intern Med 2003;138:494–501.CrossRefGoogle ScholarPubMed
9.Estrada, CA, Young, JA, Nifong, LW, Chitwood, WR JrOutcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg 2003;75:1392–1399.CrossRefGoogle ScholarPubMed
10.Smulders, K, van der Hoeven, H, Weers-Pothoff, I, Vandenbroucke-Grauls, C. A randomized clinical trial of intermittent subglottic secretion drainage in patients receiving mechanical ventilation. Chest 2002;121:858–862.CrossRefGoogle ScholarPubMed
11.Flaherty, J, Nathan, C, Kabins, SA, Weinstein, RA. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 1990;162:1393–1397.CrossRefGoogle Scholar
12.Bergmans, DC, Bonten, MJ, Gaillard, CA, et al.Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med. 2001;164:382–388.CrossRefGoogle ScholarPubMed
13.Ng, CSH, Wan, S, Yim, APC, Arifi, AA. Pulmonary dysfunction after cardiac surgery. Chest 2002;122:245–252.Google Scholar
14.Wan, S, LeClerc, JL, Vincent, JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 1997;112:676–692.CrossRefGoogle ScholarPubMed
15.Ranucci, M, Soro, G, Frigiola, A, et al.Normothermic perfusion and lung function after cardiopulmonary bypass: effects in pulmonary risk patients. Perfusion 1997;12:309–315.CrossRefGoogle ScholarPubMed
16.Sabik, JF, Gillinov, AM, Blackstone, EH, et al.Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002;124:698–707.CrossRefGoogle ScholarPubMed
17.Barquet, N, Domingo, P, Cayla, JA, et al.Prognostic factors in menin-gococcal disease. Development of a bedside predictive model and scoring system. Barcelona Meningococcal Disease Surveillance Group. JAMA 1997;278:491–496.CrossRefGoogle Scholar
18.Breiman, L, Friedman, JH, Olshen, RA, Stone, CJ. Classification and Regression Trees. Monterey: Wadsworth; 1984.Google Scholar
19.Greiner, M. Two-graph receiver operating characteristic (TG-ROC): update version supports optimization of cut-off values that minimize overall misclassification costs. J Immunol Methods 1996;191:93–94.CrossRefGoogle Scholar
20.Branca, P, McGaw, P, Light, R. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest 2001;119:537–546.CrossRefGoogle ScholarPubMed
21.Werneck, GL, Carvalho, DM, Barroso, DE, Cook, EF, Walker, AM. Classification trees and logistic regression applied to prognostic studies: a comparison using meningococcal disease as an example. J Trop Pediatr 1999;45:248–251.CrossRefGoogle ScholarPubMed
22.Thwaites, GE, Chau, TT, Stepniewska, K, et al.Diagnosis of adult tuberculous meningitis by use of clinical and laboratory features. Lancet 2002;360:1287–1292.CrossRefGoogle ScholarPubMed