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Attributable Morbidity and Mortality of Catheter-Related Septicemia in Critically Ill Patients: a Matched, Risk-Adjusted, Cohort Study

Published online by Cambridge University Press:  02 January 2015

Lilia Soufir
Affiliation:
Service de réanimation polyvalente, Hôpital Saint-Joseph, Paris, France
Jean-François Timsit*
Affiliation:
Clinique de réanimation des maladies infectieuses, Hôpital Universitaire Bichat Claude-Bernard, Paris, France Service de réanimation polyvalente, Hôpital Saint-Joseph, Paris, France
Cédric Mahe
Affiliation:
Département de Biostatistique et Informatique Médicale, Hôpital Universitaire Saint-Louis, Paris, France
Jean Carlet
Affiliation:
Service de réanimation polyvalente, Hôpital Saint-Joseph, Paris, France
Bernard Regnier
Affiliation:
Clinique de réanimation des maladies infectieuses, Hôpital Universitaire Bichat Claude-Bernard, Paris, France
Sylvie Chevret
Affiliation:
Département de Biostatistique et Informatique Médicale, Hôpital Universitaire Saint-Louis, Paris, France
*
Réanimation polyvalente, Hôpital Saint Joseph, 185 rue Raymond Losserand, 75014 Paris, France

Abstract

Objective:

To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS.

Design:

Pairwise-matched (1:2) exposed-unexposed study.

Setting:

10-bed medical-surgical ICU and an 18-bed medical ICU.

Patients:

Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.

Methods:

Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality.

Results:

CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI95, 0.76-2.61; P=.27).

Conclusion:

CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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