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Predictive risk factors for postoperative pneumonia after heart transplantation.
BMC Anesthesiology ( IF 2.2 ) Pub Date : 2020-01-07 , DOI: 10.1186/s12871-019-0923-3
Charles Vidal 1, 2 , Romain Pasqualotto 1 , Arthur James 1 , Pauline Dureau 1 , Julie Rasata 1 , Guillaume Coutance 3 , Shaida Varnous 3 , Pascal Leprince 3 , Julien Amour 1 , Adrien Bouglé 1
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BACKGROUND Pneumonia is a frequent complication in patients undergoing heart transplantation (HTx) that increases morbidity and mortality in this population. Nevertheless, the risk factors for postoperative pneumonia (POP) are still unknown. The aim of this study was to investigate the predictive risk factors for POP in HTx recipients. METHODS In this retrospective study, all patients undergoing HTx between January 2014 and December 2015 were included. All cases of POP occurring until hospital discharge were investigated. The study aimed to determine risk factors using univariate and multivariate Cox regression models. Data are expressed in Odds Ratio [95% CI]. P < 0.05 was necessary to reject the null hypothesis. RESULTS A total of 175 patients were included without any patients being lost to follow-up, and 89 instances of POP were diagnosed in 59 (34%) patients. Enterobacteriaceae and Pseudomonas aeruginosa were the most common pathogens. In the multivariate analysis, the risk factors were preoperative mechanical ventilation (OR 1.42 [1.12-1.80], P < 0.01) and perioperative blood transfusion (OR 1.42 [95% CI: 1.20-1.70], P < 0.01). POP significantly impacted mortality at 30 days (OR: 4 [1.3-12.4], P = 0.01) and 1 year (OR: 6.8 [2.5-8.4], P < 0.01) and was associated with a longer duration of mechanical ventilation, time to weaning from venoarterial extracorporeal membrane oxygenation and stay in an intensive care unit. Plasma exchanges and intravenous administration of immunoglobulins did not increase the risk of POP. CONCLUSION After HTx, preoperative mechanical ventilation and blood transfusion were risk factors for POP and were associated with increased mortality. Enterobacteriaceae and Pseudomonas aeruginosa are the most common pathogens of POP.

中文翻译:

心脏移植术后肺炎的预测危险因素。

背景技术肺炎是接受心脏移植(HTx)的患者中的常见并发症,其增加了该人群的发病率和死亡率。然而,术后肺炎(POP)的危险因素仍然未知。这项研究的目的是调查HTx受体中POP的预测危险因素。方法这项回顾性研究纳入了2014年1月至2015年12月期间接受HTx治疗的所有患者。调查了直到出院为止的所有POP病例。该研究旨在使用单变量和多变量Cox回归模型确定风险因素。数据以赔率[95%CI]表示。P <0.05是拒绝原假设的必要条件。结果总共纳入了175名患者,没有任何患者失去随访,59例(34%)患者被诊断出POP实例89例。肠杆菌科和铜绿假单胞菌是最常见的病原体。在多变量分析中,危险因素为术前机械通气(OR 1.42 [1.12-1.80],P <0.01)和围手术期输血(OR 1.42 [95%CI:1.20-1.70],P <0.01)。POP显着影响30天(OR:4 [1.3-12.4],P = 0.01)和1年(OR:6.8 [2.5-8.4],P <0.01)的死亡率,并与更长的机械通气时间相关停止从静脉大动脉体外膜氧合作用断奶,并留在重症监护室。血浆交换和静脉注射免疫球蛋白不会增加POP的风险。结论HTx之后,术前机械通气和输血是POP的危险因素,并与死亡率增加相关。肠杆菌科和铜绿假单胞菌是POP最常见的病原体。
更新日期:2020-01-07
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