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

Andrea Cortegiani, Fabiana Madotto, Cesare Gregoretti, Giacomo Bellani, John G. Laffey, Tai Pham, Frank Van Haren, Antonino Giarratano, Massimo Antonelli, Antonio Pesenti, Giacomo Grasselli, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina S. Insaurralde, Risso V. Alejandro, Julio Daldin, Mauricio VinzioRuben 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 Q. Wu, Xiao B. Huang, Zhenyang He, Yuanhua Lu, Hui Han, Fan Zhang, Renhua Sun, Hua X. Wang, Shu H. Qin, Bao H. Zhu, Jun Zhao, Jian Liu, Bin Li, Jing L. Liu, Fa C. Zhou, Qiong J. Li, Xing Y. Zhang, Zhou Li-Xin, Qiang Xin-Hua, Liangyan Jiang, Yuan N. Gao, Xian Y. Zhao, Yuan Y. Li, Xiao L. Li, Chunting Wang, Qingchun Yao, Rongguo Yu, Kai Chen, Huanzhang Shao, Bingyu Qin, Qing Q. Huang, Wei H. Zhu, Ai Y. Hang, Ma X. Hua, Yimin Li, Yonghao Xu, Yu D. Di, Long L. Ling, Tie H. Qin, Shou H. Wang, Junping Qin, Yi Han, Suming Zhou, Monica P. Vargas, Juan I. 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 G. 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 H. Zogheib, Herve Dupont, Sylvie Ricome, Francesco L. Santoli, Sebastien L. Besset, Philippe Michel, Bruno Gelée, Pierre Eric Danin, Bernard Goubaux, Philippe J. Crova, Nga T. Phan, Frantz Berkelmans, Julio C. 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 R. Richecoeur, Daniele M. Combaux, Fabien Grelon, Charlene Le Moal, Elise P. 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 D. Zacharowski, Patrick Meybohm, Andreas W. Reske, Philipp Simon, Hans Bernd F. Hopf, Michael Schuetz, Thomas Baltus, Metaxia N. Papanikolaou, Theonymfi G. Papavasilopoulou, Giannis A. Zacharas, Vasilis Ourailogloy, Eleni K. Mouloudi, Eleni V. Massa, Eva O. Nagy, Electra E. Stamou, Ellada V. Kiourtzieva, Marina A. Oikonomou, Luis E. Avila, Cesar A. Cortez, Johanna E. Citalán, Sameer A. Jog, Safal D. Sable, Bhagyesh Shah, Mohan Gurjar, Arvind K. Baronia, Mohammedfaruk Memon, Radhakrishnan Muthuchellappan, Venkatapura J. Ramesh, Anitha Shenoy, Ramesh Unnikrishnan, Subhal B. Dixit, Rachana V. Rhayakar, Nagarajan Ramakrishnan, Vallish K. Bhardwaj, Heera L. Mahto, Sudha V. Sagar, Vijayanand Palaniswamy, Deeban Ganesan, Seyed Mohammadreza Hashemian, Hamidreza Jamaati, Farshad Heidari, Edel A. Meaney, Alistair Nichol, Karl M. Knapman, Donall O'Croinin, Eimhin S. Dunne, Dorothy M. Breen, Kevin P. Clarkson, Rola F. Jaafar, Rory Dwyer, Fahd Amir, Olaitan O. Ajetunmobi, Aogan C. O'Muircheartaigh, Colin S. Black, Nuala Treanor, Daniel V. 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, Massimo M. Antonelli, Luca M. Montini, Paolo Casalena, Sergio Scafetti, Giovanna Panarello, Giovanna Occhipinti, Nicolò Patroniti, Matteo Pozzi, Roberto R. 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 E. Borotto, Andrea N. Cracchiolo, Daniela M. Palma, Francesco Raponi, Giuseppe Foti, Ettore R. Vascotto, Andrea Coppadoro, Luca Brazzi, Leda Floris, Giorgio A. Iotti, Aaron Venti, Osamu Yamaguchi, Shunsuke Takagi, Hiroki N. 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 Y. Liew, Silvio A. Ñamendys-Silva, Yves D. Jarquin-Badiola, Luis A. Sanchez-Hurtado, Saira S. Gomez-Flores, Maria C. Marin, Asisclo J. Villagomez, Jordana S. Lemus, Jonathan M. Fierro, Mavy Ramirez Cervantes, Francisco Javier Flores Mejia, Dulce Dector, Dulce M. Dector, Daniel R. Gonzalez, Claudia R. Estrella, Jorge R. Sanchez-Medina, Alvaro Ramirez-Gutierrez, Fernando G. George, Janet S. Aguirre, Juan A. 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 M. Bruns, Jeroen A. Schouten, Myra Rinia, Monique Raaijmakers, Leo M. Heunks, Hellen M. Van Wezel, Serge J. Heines, Ulrich Strauch, Marc P. Buise, Fabienne D. Simonis, Marcus J. Schultz, Jennifer C. Goodson, Troy S. Browne, Leanlove Navarra, Anna Hunt, Robyn A. Hutchison, Mathew B. Bailey, Lynette Newby, Colin Mcarthur, Michael Kalkoff, Alex Mcleod, Jonathan Casement, Danielle J. Hacking, Finn H. Andersen, Merete S. Dolva, Jon H. Laake, Andreas Barratt-Due, Kim Andre Noremark, Eldar Søreide, Brit A. Sjøbø, Anne B. Guttormsen, Hector H. Leon Yoshido, Ronald Zumaran Aguilar, Fredy A.Montes Oscanoa, Alain U. Alisasis, Joanne B. Robles, Rossini Abbie Pasanting-Lim, Beatriz C. Tan, Pawel Andruszkiewicz, Karina Jakubowska, Cristina M. Coxo, António M. Alvarez, Bruno S. Oliveira, Gustavo M. Montanha, Nelson C. Barros, Carlos S. Pereira, António M. Messias, Jorge M. Monteiro, Ana M. Araujo, Nuno T. Catorze, Susan M. Marum, Maria J. Bouw, Rui M. Gomes, Vania A. Brito, Silvia Castro, Joana M. Estilita, Filipa M. Barros, Isabel M. Serra Aurelia, Dana R. Tomescu, Alexandra Marcu, Ovidiu H. Bedreag, Marius Papurica, Dan E. Corneci, Silvius Ioan Negoita, Evgeny Grigoriev, Alexey I. Gritsan, Andrey A. Gazenkampf, Ghaleb Almekhlafi, Mohamad M. Albarrak, Ghanem M. Mustafa, Khalid A. Maghrabi, Nawal Salahuddin, Tharwat M. Aisa, Ahmed S. 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 C. Lopez-Delgado, Francisco Esteve, Gemma Rialp, Catalina Forteza, Candelaria de Haro, Antonio Artigas, Guillermo M. Albaiceta, Sara de Cima-Iglesias, Leticia Seoane-Quiroga, Alexandra Ceniceros-Barros, Antonio L. 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 P. Perez, Cesar P. Perez, Raquel Montoiro Allue, Ferran Roche-Campo, Marco Ibañez-Santacruz, Susana Temprano, Maria C. Pintado, Raul de Pablo, Pilar Ricart Aroa Gómez, Silvia Rodriguez Ruiz, Silvia Iglesias Moles, Maria Teresa Jurado, Alfons Arizmendi, Enrique A. Piacentini, Nieves Franco, Teresa Honrubia, Meisy Perez Cheng, Elena Perez Losada, Javier Blanco, Luis J. Yuste, Cecilia Carbayo-Gorriz, Francisca G. Cazorla-Barranquero, Javier G. Alonso, Rosa S. 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Broman, Joanna Wessbergh, Linnea Persson, Fredrik Schiöler, Hans Kedelv, Anna Oscarsson Tibblin, Henrik Appelberg, Lars Hedlund, Johan Helleberg, Karin E. Eriksson, Rita Glietsch, Niklas Larsson, Ingela Nygren, Silvia L. Nunes, Anna Karin Morin, Thomas Kander, Anne Adolfsson, Lise Piquilloud, Hervé O. 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 O. 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 S. Raj, Danielle A. Fawkes, Philip Watt, Linda Twohey, Rajeev R. Jha, Matthew Thomas, Alex Morton, Varsha Kadaba, Mark J. Smith, Anil P. Hormis, Santhana G. Kannan, Miriam Namih, Henrik Reschreiter, Julie Camsooksai, Alek Kumar, Szabolcs Rugonfalvi, Christopher Nutt, Orla Oneill, Colette Seasman, Ged Dempsey, Christopher J. Scott, Helen E. Ellis, Stuart Mckechnie, Paula J. Hutton, Nora N. Di Tomasso, Michela N. Vitale, Ruth Griffin, Michael N. Dean, Julius H. Cranshaw, Emma L. Willett, Nicholas Ioannou, Sarah Gillis, Peter Csabi, Rosaleen Macfadyen, Heidi Dawson, Pieter D. Preez, Alexandra J. Williams, Owen Boyd, Laura Ortiz Ruiz de Gordoa, Jon Bramall, Sophie Symmonds, Simon K. Chau, Tim Wenham, Tamas Szakmany, Piroska Toth-Tarsoly, Katie H. Mccalman, Peter Alexander, Lorraine Stephenson, Thomas Collyer, Rhiannon Chapman, Raphael Cooper, Russell M. Allan, Malcolm Sim, David W. Wrathall, Donald A. Irvine, Kim S. Zantua, John C. Adams, Andrew J. Burtenshaw, Gareth P. Sellors, Ingeborg D. Welters, Karen E. Williams, Robert J. Hessell, Matthew G. Oldroyd, Ceri E. Battle, Suresh Pillai, Istvan Kajtor, Mageswaran Sivashanmugavel, Sinead C. Okane, Adrian Donnelly, Aniko D. Frigyik, Jon P. Careless, Martin M. May, Richard Stewart, T. John Trinder, Samantha J. Hagan, Matt P. Wise, Jade M. Cole, Caroline C. MacFie, Anna T. Dowling, Javier Hurtado, Nicolás Nin, Edgardo Nuñez, Gustavo Pittini, Ruben Rodriguez, María C. Imperio, Cristina Santos, Ana G. França, Alejandro Ebeid, Alberto Deicas, Carolina Serra, Aditya Uppalapati, Ghassan Kamel, Valerie M. Banner-Goodspeed, Jeremy R. Beitler, Satyanarayana Reddy Mukkera, Shreedhar Kulkarni, Jarone Lee, Tomaz Mesar, Christopher Tainter, John O. Shinn, Dina Gomaa, Dale J. Yeatts, Jessica Warren, Michael J. Lanspa, Russel R. Miller, Colin K. Grissom, Samuel M. Brown, Philippe R. Bauer, Ryan J. Gosselin, Barrett T. Kitch, Jason E. Cohen, Scott H. Beegle, Shazia Choudry, Renaud M. Gueret, Aiman Tulaimat, William Stigler, Hitesh Batra, Nidhi G. Huff, Keith D. Lamb, Trevor W. Oetting, Nicholas M. Mohr, Claine Judy, Shigeki Saito, Fayez M. Kheir, Fayez Kheir, Adam B. Schlichting, Angela Delsing, Daniel R. Crouch, Mary Elmasri, Dina Ismail, Kyle R. Dreyer, Thomas C. Blakeman, Rebecca M. Baron, Carolina Quintana Grijalba, Peter C. 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 M. Francois, Francesca Rabboni, Sara Conti, Fernando Rios, T. Sottiaux, Fredy S. 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

Research output: Contribution to journalArticle

28 Citations (Scopus)

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
Article number157
JournalCritical Care
Volume22
Issue number1
DOIs
Publication statusPublished - Jun 12 2018

Keywords

  • ARDS
  • Acute respiratory failure
  • Immunocompromised patients
  • Mechanical ventilation
  • Noninvasive ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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