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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

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

Authors: Andrea Cortegiani, Fabiana Madotto, Cesare Gregoretti, Giacomo Bellani, John G. Laffey, Tai Pham, Frank Van Haren, Antonino Giarratano, Massimo Antonelli, Antonio Pesenti, Giacomo Grasselli, LUNG SAFE Investigators and the ESICM Trials Group

Published in: Critical Care | Issue 1/2018

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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.
Appendix
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Metadata
Title
Immunocompromised patients with acute respiratory distress syndrome: secondary analysis of the LUNG SAFE database
Authors
Andrea Cortegiani
Fabiana Madotto
Cesare Gregoretti
Giacomo Bellani
John G. Laffey
Tai Pham
Frank Van Haren
Antonino Giarratano
Massimo Antonelli
Antonio Pesenti
Giacomo Grasselli
LUNG SAFE Investigators and the ESICM Trials Group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2079-9

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