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

Massimo Antonelli, Luca Montini, Andrea Cortegiani, Fabiana Madotto, Cesare Gregoretti, Giacomo Bellani, John G. Laffey, Tai Pham, Frank Van Haren, Antonino Giarratano, Antonio Pesenti, Giacomo Grasselli, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina S. Insaurralde, Risso V. Alejandro, Julio DaldinMauricio Vinzio, Ruben 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, Valeria I. Cerrato, Marco G. Bezzi, Silvina A. Borello, Flavia A. Loiacono, Adriana M. Fernandez, Serena Knowles, Claire Reynolds, Deborah M. Inskip, Jennene J. Miller, Jing Kong, Christina Whitehead, Shailesh Bihari, Aylin Seven, Amanda Krstevski, Helen J. Rodgers, Rebecca T. Millar, Toni E. Mckenna, Irene M. Bailey, Gabrielle C. Hanlon, Anders Aneman, Joan M. Lynch, Raman Azad, John Neal, Paul W. Woods, Brigit L. Roberts, Mark R. Kol, Helen S. Wong, Katharina C. Riss, Thomas Staudinger, Xavier Wittebole, Caroline Berghe, Pierre A. Bulpa, Alain M. Dive, Rik Verstraete, Herve Lebbinck, Pieter Depuydt, Joris Vermassen, Philippe Meersseman, Helga Ceunen, Jonas I. Rosa, Daniel O. Beraldo, Claudio Piras, Adenilton M. Rampinelli, Antonio P. Nassar, Sergio Mataloun, Marcelo Moock, Marlus M. Thompson, Claudio H. Gonçalves, Ana Carolina P. Antônio, Aline Ascoli, Rodrigo S. Biondi, Danielle C. Fontenele, Danielle Nobrega, Vanessa M. Sales Brunei, Suresh Shindhe, Dayangku Hajah Maizatul Aiman Binti Pengiran Haji Ismail, Francois Beloncle, Kyle G. Davies, Rob Cirone, Venika Manoharan, Mehvish Ismail, Ewan C. Goligher, Mandeep Jassal, Erin Nishikawa, Areej Javeed, Gerard Curley, Nuttapol Rittayamai, Matteo Parotto, Niall D. Ferguson, Sangeeta Mehta, Jenny Knoll, Antoine Pronovost, Sergio Canestrini, Alejandro R. Bruhn, Patricio H. Garcia, Felipe A. Aliaga, Pamela A. Farías, Jacob S. Yumha, Claudia A. Ortiz, Javier E. Salas, Alejandro A. Saez, Luis D. Vega, Eduardo F. Labarca, Felipe T. Martinez, Nicolás G. Carreño, Pilar Lora, Haitao Liu, Haibo Qiu, Ling Liu, Rui Tang, Xiaoming Luo, Youzhong An, Huiying Zhao, Yan Gao, Zhe Zhai, Zheng L. Ye, Wei Wang, Wenwen Li, Qingdong Li, Ruiqiang Zheng, Wenkui Yu, Juanhong Shen, Xinyu Li, Tao Yu, Weihua Lu, Ya Wu, Xiao B. Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua Wang, Shu H. Qin, Bao Zhu, Jun Zhao, Jian Liu, Bin Li, Jing Liu, Fa C. Zhou, Qiong Li, Xing Y. Zhang, Zhou Li-Xin, Qiang Xin-Hua, Liangyan Jiang, Yuan Gao, Xian Y. Zhao, Yuan Li, Xiao L. Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Huang, Wei H. Zhu, Ai Hang, Ma X. Hua, Yimin Li, Yonghao Xu, Yu Di, Long L. Ling, Tie Qin, Shou H. Wang, Junping Qin, Yi Han, Suming Zhou, Monica Vargas, Juan Silesky Jimenez, Manuel A. González Rojas, Jaime E. Solis-Quesada, Christian M. Ramirez-Alfaro, Jan Máca, Peter Sklienka, Jakob Gjedsted, Aage Christiansen, Jonas Nielsen, Boris Villamagua, Miguel Llano, Philippe Burtin, Gautier Buzancais, Pascal Beuret, Nicolas Pelletier, Satar Mortaza, Alain Mercat, Jonathan Chelly, Sébastien Jochmans, Nicolas Terzi, Cédric Daubin, Guillaume Carteaux, Nicolas De Prost, Jean-Daniel Chiche, Fabrice Daviaud, Muriel Fartoukh, Guillaume Barberet, Jerome Biehler, Jean Dellamonica, Denis Doyen, Jean-Michel Arnal, Anais Briquet, Sami Hraiech, Laurent Papazian, Arnaud Follin, Damien Roux, Jonathan Messika, Evangelos Kalaitzis, Laurence Dangers, Alain Combes, Siu-Ming Au, Gaetan Béduneau, Dorothée Carpentier, Elie Zogheib, Herve Dupont, Sylvie Ricome, Francesco L. Santoli, Sebastien Besset, Philippe Michel, Bruno Gelée, Pierre-Eric Danin, Bernard Goubaux, Philippe Crova, Nga T. Phan, Frantz Berkelmans, Julio Badie, Romain Tapponnier, Josette Gally, Samy Khebbeb, Jean-Etienne Herbrecht, Francis Schneider, Pierre-Louis M. Declercq, Jean-Philippe Rigaud, Jacques Duranteau, Anatole Harrois, Russell Chabanne, Julien Marin, Charlene Bigot, Sandrine Thibault, Mohammed Ghazi, Messabi Boukhazna, Salem Ould Zein, Jack Richecoeur, Daniele M. Combaux, Fabien Grelon, Charlene Le Moal, Elise Sauvadet, Adrien Robine, Virginie Lemiale, Danielle Reuter, Martin Dres, Alexandre Demoule, Dany Goldgran-Toledano, Loredana Baboi, Claude Guérin, Ralph Lohner, Jens Krabler, Susanne Schäfer, Kai Zacharowski, Patrick Meybohm, Andreas Reske, Philipp Simon, Hans-Bernd F. Hopf, Michael Schuetz, Thomas Baltus, Metaxia Papanikolaou, Theonymfi G. Papavasilopoulou, Giannis Zacharas, Vasilis Ourailogloy, Eleni Mouloudi, Eleni V. Massa, Eva Nagy, Electra E. Stamou, Ellada Kiourtzieva, Marina A. Oikonomou, Luis Avila, Cesar Cortez, Johanna E. Citalán, Sameer Jog, Safal D. Sable, Bhagyesh Shah, Mohan Gurjar, Arvind K. Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura J. Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal Dixit, Rachana V. Rhayakar, Nagarajan Ramakrishnan, Vallish K. Bhardwaj, Heera Mahto, Sudha V. Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Mohammadreza Hashemian, Hamidreza Jamaati, Farshad Heidari, Edel Meaney, Alistair Nichol, Karl Knapman, Donall O'Croinin, Eimhin Dunne, Dorothy M. Breen, Kevin Clarkson, Rola F. Jaafar, Rory Dwyer, Fahd Amir, Olaitan Ajetunmobi, Aogan C. O'Muircheartaigh, Colin Black, Nuala Treanor, Daniel Collins, Wahid Altaf, Gianluca Zani, Maurizio Fusari, Savino Spadaro, Carlo A. Volta, Romano Graziani, Barbara Brunettini, Salvatore Palmese, Paolo Formenti, Michele Umbrello, Andrea Lombardo, Elisabetta Pecci, Marco Botteri, Monica Savioli, Alessandro Protti, Alessia Mattei, Lorenzo Schiavoni, Andrea Tinnirello, Manuel Todeschini, Sara Sher, Anna Rossi, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto Biscione, Michela M. Poli, Ferdinando Raimondi, Daniela Albiero, Giulia Crapelli, Eduardo Beck, Vincenzo Pota, Vincenzo Schiavone, Alexandre Molin, Fabio Tarantino, Giacomo Monti, Elena Frati, Lucia Mirabella, Gilda Cinnella, Tommaso Fossali, Riccardo Colombo, Pierpaolo Terragni Ilaria Pattarino, Francesco Mojoli, Antonio Braschi, Erika Borotto, Andrea Cracchiolo, Daniela M. Palma, Francesco Raponi, Giuseppe Foti, Ettore Vascotto, Andrea Coppadoro, Luca Brazzi, Leda Floris, Giorgio Iotti, Aaron Venti, Osamu Yamaguchi, Shunsuke Takagi, Hiroki Maeyama, Eizo Watanabe, Yoshihiro Yamaji, Kazuyoshi Shimizu, Kyoko Shiozaki, Satoru Futami, Sekine Ryosuke, Koji Saito, Yoshinobu Kameyama, Keiko Ueno, Masayo Izawa, Nao Okuda, Hiroyuki Suzuki, Tomofumi Harasawa, Michitaka Nasu, Tadaaki Takada, Fumihito Ito, Shin Nunomiya, Kansuke Koyama, Toshikazu Abe, Kohkichi Andoh, Kohei Kusumoto, Akira Hirata, Akihiro Takaba, Hiroyasu Kimura, Shuhei Matsumoto, Ushio Higashijima, Hiroyuki Honda, Nobumasa Aoki, Hiroshi Imai, Yasuaki Ogino, Ichiko Mizuguchi, Kazuya Ichikado, Kenichi Nitta, Katsunori Mochizuki, Tomoaki Hashida, Hiroyuki Tanaka, Tomoyuki Nakamura, Daisuke Niimi, Takeshi Ueda, Yozo Kashiwa, Akinori Uchiyama, Olegs Sabelnikovs, Peteris Oss, Youssef Haddad, Kong Liew, Silvio A. Ñamendys-Silva, Yves D. Jarquin-Badiola, Luis Sanchez-Hurtado, Saira S. Gomez-Flores, Maria Marin, Asisclo J. Villagomez, Jordana Lemus, Jonathan M. Fierro, Mavy Ramirez Cervantes, Francisco Javier Flores Mejia, Dulce Dector, Dulce M. Dector, Daniel Gonzalez, Claudia R. Estrella, Jorge Sanchez-Medina, Alvaro Ramirez-Gutierrez, Fernando George, Janet S. Aguirre, Juan Buensuseso, Manuel Poblano, Tarek Dendane, Amine Ali Zeggwagh, Hicham Balkhi, Mina Elkhayari, Nacer Samkaoui, Hanane Ezzouine, Abdellatif Benslama, Mourad Amor, Wajdi Maazouzi, Nedim Cimic, Oliver Beck, Monique Bruns, Jeroen A. Schouten, Myra Rinia, Monique Raaijmakers, Leo Heunks, Hellen M. Van Wezel, Serge Heines, Ulrich Strauch, Marc Buise, Fabienne Simonis, Marcus J. Schultz, Jennifer Goodson, Troy S. Browne, Leanlove Navarra, Anna Hunt, Robyn Hutchison, Mathew B. Bailey, Lynette Newby, Colin Mcarthur, Michael Kalkoff, Alex Mcleod, Jonathan Casement, Danielle J. Hacking, Finn Andersen, Merete S. Dolva, Jon Laake, Andreas Barratt-Due, Kim Andre Noremark, Eldar Søreide, Brit A. Sjøbø, Anne B. Guttormsen, Hector Leon Yoshido, Ronald Zumaran Aguilar, Fredy A. Montes Oscanoa, Alain Alisasis, Joanne B. Robles, Rossini Abbie Pasanting-Lim, Beatriz C. Tan, Pawel Andruszkiewicz, Karina Jakubowska, Cristina Coxo, António Alvarez, Bruno S. Oliveira, Gustavo Montanha, Nelson C. Barros, Carlos Pereira, António M. Messias, Jorge Monteiro, Ana Araujo, Nuno T. Catorze, Susan Marum, Maria J. Bouw, Rui Gomes, Vania A. Brito, Silvia Castro, Joana M. Estilita, Filipa Barros, Isabel Serra Aurelia, Dana Tomescu, Alexandra Marcu, Ovidiu Bedreag, Marius Papurica, Dan Corneci, Silvius Ioan Negoita, Evgeny Grigoriev, Alexey Gritsan, Andrey A. Gazenkampf, Ghaleb Almekhlafi, Mohamad M. Albarrak, Ghanem M. Mustafa, Khalid Maghrabi, Nawal Salahuddin, Tharwat Aisa, Ahmed Al Jabbary, Edgardo Tabhan, Yaseen M. Arabi, Olivia A. Trinidad, Hasan M. Al Dorzi, Edgardo E. Tabhan, Stefan Bolon, Oliver Smith, Jordi Mancebo, Hernan Aguirre-Bermeo, Juan Lopez-Delgado, Francisco Esteve, Gemma Rialp, Catalina Forteza, Candelaria De Haro, Antonio Artigas, Guillermo Albaiceta, Sara De Cima-Iglesias, Leticia Seoane-Quiroga, Alexandra Ceniceros-Barros, Antonio Ruiz-Aguilar, Luis M. Claraco-Vega, Juan Alfonso Soler, Maria Del Carmen Lorente, Cecilia Hermosa, Federico Gordo, Miryam Prieto-González, Juan B. López-Messa, Manuel Perez, Cesar P. Perez, Raquel Montoiro Allue, Ferran Roche-Campo, Marco Ibañez-Santacruz, Susana Temprano, Maria Pintado, Raul De Pablo, Pilar Ricart Aroa Gómez, Silvia Rodriguez Ruiz, Silvia Iglesias Moles, Maria Teresa Jurado, Alfons Arizmendi, Enrique Piacentini, Nieves Franco, Teresa Honrubia, Meisy Perez Cheng, Elena Perez Losada, Javier Blanco, Luis J. Yuste, Cecilia Carbayo-Gorriz, Francisca G. Cazorla-Barranquero, Javier Alonso, Rosa S. Alda, Ángela Algaba, Gonzalo Navarro, Enrique Cereijo, Esther Diaz-Rodriguez, Diego Pastor Marcos, Laura Alvarez Montero, Luis Herrera Para, Roberto Jimenez Sanchez, Miguel Angel Blasco Navalpotro, Ricardo Diaz Abad, Raquel Montiel González, Dácil Parrilla Toribio, Alejandro Castro, Maria Jose D. Artiga, Oscar Penuelas, Tomas Roser, Moreno F. Olga, Elena Gallego Curto, Rocío Manzano Sánchez, Vallverdu Imma, Garcia M. Elisabet, Laura Claverias, Monica Magret, Ana Pellicer, Lucia L. Rodriguez, Jesús Sánchez-Ballesteros, Ángela González-Salamanca, Antonio Jimenez, Francisco P. Huerta, Juan Carlos Sotillo Diaz, Esther Bermejo Lopez, David Llinares Moya, Alec A. Tallet Alfonso, Palazon Sanchez Eugenio Luis, Palazon Sanchez Cesar, Sánchez I. Rafael, Corcoles G. Virgilio, Noelia Recio, Richard Adamsson, Christian C. Rylander, Bernhard Holzgraefe, Lars M. Broman, Joanna Wessbergh, Linnea Persson, Fredrik Schiöler, Hans Kedelv, Anna Oscarsson Tibblin, Henrik Appelberg, Lars Hedlund, Johan Helleberg, Karin Eriksson, Rita Glietsch, Niklas Larsson, Ingela Nygren, Silvia Nunes, Anna-Karin Morin, Thomas Kander, Anne Adolfsson, Lise Piquilloud, Hervé Zender, Corinne Leemann-Refondini, Souheil Elatrous, Slaheddine Bouchoucha, Imed Chouchene, Islem Ouanes, Asma Ben Souissi, Salma Kamoun, Oktay Demirkiran, Mustafa Aker, Emre Erbabacan, Ilkay Ceylan, Nermin Kelebek Girgin, Menekse Ozcelik, Necmettin Ünal, Basak Ceyda Meco, Onat Akyol, Suleyman S. Derman, Barry Kennedy, Ken Parhar, Latha Srinivasa, Lia Mcnamee, Danny Mcauley, Phil Hopkins, Clare Mellis, Vivek Kakar, Dan Hadfield, Andre Vercueil, Kaushik Bhowmick, Sally K. Humphreys, Andrew Ferguson, Raymond Mckee, Ashok Raj, Danielle A. Fawkes, Philip Watt, Linda Twohey, Rajeev Jha, Matthew Thomas, Alex Morton, Varsha Kadaba, Mark Smith, Anil P. Hormis, Santhana Kannan, Miriam Namih, Henrik Reschreiter, Julie Camsooksai, Alek Kumar, Szabolcs Rugonfalvi, Christopher Nutt, Orla Oneill, Colette Seasman, Ged Dempsey, Christopher Scott, Helen E. Ellis, Stuart Mckechnie, Paula J. Hutton, Nora Di Tomasso, Michela N. Vitale, Ruth Griffin, Michael N. Dean, Julius Cranshaw, Emma L. Willett, Nicholas Ioannou, Sarah Gillis, Peter Csabi, Rosaleen Macfadyen, Heidi Dawson, Pieter Preez, Alexandra J. Williams, Owen Boyd, Laura Ortiz-Ruiz De Gordoa, Jon Bramall, Sophie Symmonds, Simon Chau, Tim Wenham, Tamas Szakmany, Piroska Toth-Tarsoly, Katie Mccalman, Peter Alexander, Lorraine Stephenson, Thomas Collyer, Rhiannon Chapman, Raphael Cooper, Russell Allan, Malcolm Sim, David Wrathall, Donald A. Irvine, Kim Zantua, John C. Adams, Andrew Burtenshaw, Gareth P. Sellors, Ingeborg Welters, Karen E. Williams, Robert Hessell, Matthew G. Oldroyd, Ceri Battle, Suresh Pillai, Istvan Kajtor, Mageswaran Sivashanmugavel, Sinead Okane, Adrian Donnelly, Aniko Frigyik, Jon P. Careless, Martin May, Richard Stewart, T. John Trinder, Samantha J. Hagan, Matt Wise, Jade M. Cole, Caroline Macfie, Anna T. Dowling, Javier Hurtado, Nicolás Nin, Edgardo Nuñez, Gustavo Pittini, Ruben Rodriguez, María C. Imperio, Cristina Santos, Ana França, Alejandro Ebeid, Alberto Deicas, Carolina Serra, Aditya Uppalapati, Ghassan Kamel, Valerie Banner-Goodspeed, Jeremy R. Beitler, Satyanarayana Reddy Mukkera, Shreedhar Kulkarni, Jarone Lee, Tomaz Mesar, Christopher Tainter, John O. Shinn Iii, Dina Gomaa, Dale Yeatts, Jessica Warren, Michael Lanspa, Russel R. Miller, Colin K. Grissom, Samuel M. Brown, Philippe Bauer, Ryan Gosselin, Barrett T. Kitch, Jason Cohen, Scott H. Beegle, Shazia Choudry, Renaud Gueret, Aiman Tulaimat, William Stigler, Hitesh Batra, Nidhi Huff, Keith Lamb, Trevor W. Oetting, Nicholas Mohr, Claine Judy, Shigeki Saito, Fayez M. Kheir, Fayez Kheir, Adam Schlichting, Angela Delsing, Daniel Crouch, Mary Elmasri, Dina Ismail, Kyle Dreyer, Thomas C. Blakeman, Rebecca Baron, Carolina Quintana Grijalba, Peter Hou, Raghu Seethala, Imo Aisiku, Galen Henderson, Gyorgy Frendl, Sen-Kuang Hou, Robert L. Owens, Ashley Schomer, Vesna Bumbasirevic, Bojan Jovanovic, Maja Surbatovic, Milic Veljovic, Guy Francois, Francesca Rabboni, Sara Conti, Fernando Rios, T. Sottiaux, Fredy Lora, Luciano Cesar Azevedo, Eddy Fan, Guillermo Bugedo, Marcos Gonzalez, Juan Silesky, Vladimir Cerny, Manuel Jibaja, Hermann Wrigge, Dimitrios Matamis, Jorge Luis Ranero, Pravin Amin, Kevin Clarkson, Kiyoyasu Kurahashi, Asisclo Villagomez, Jose Emmanuel Palo, Antero Do Vale Fernandes, Dorel Sandesc, Yaasen Arabi, Vesna Bumbasierevic, Jose A. Lorente, Anders Larsson, Fekri Abroug, Ed Bajwa, Gabriel Démpair

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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.
Original languageEnglish
Pages (from-to)157-N/A
JournalCritical Care
Volume22
DOIs
Publication statusPublished - 2018

Keywords

  • ARDS
  • Acute respiratory failure
  • Critical Care and Intensive Care Medicine
  • Immunocompromised patients
  • Mechanical ventilation
  • Noninvasive ventilation

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