Intensive care unit (ICU)-acquired bacteraemia and ICU mortality and discharge: addressing time-varying confounding using appropriate methodology

被引:23
|
作者
Pouwels, K. B. [1 ,2 ,3 ]
Vansteelandt, S. [4 ]
Batra, R. [5 ,6 ]
Edgeworth, J. D. [5 ,6 ]
Smieszek, T. [1 ,3 ]
Robotham, J. V. [1 ]
机构
[1] Publ Hlth England, Natl Infect Serv, Modelling & Econ Unit, 61 Colindale Ave, London NW9 5EQ, England
[2] Univ Groningen, Dept Pharm, Unit PharmacoTherapy Epidemiol & Econ, Groningen, Netherlands
[3] Imperial Coll, Sch Publ Hlth, Dept Infect Dis Epidemiol, MRC Ctr Outbreak Anal & Modelling, London, England
[4] Univ Ghent, Fac Sci, Dept Appl Math Comp Sci & Stat, Ghent, Belgium
[5] Kings Coll London, Dept Infect Dis, Ctr Clin Infect & Diagnost Res, London, England
[6] Guys & St Thomas NHS Fdn Trust, London, England
关键词
Burden; Intensive care units; Bacteraemia; Inverse probability weighting; Bias; BLOOD-STREAM INFECTIONS; MARGINAL STRUCTURAL MODELS; ATTRIBUTABLE MORTALITY; NOSOCOMIAL INFECTIONS; MULTISTATE MODELS; RISK-FACTORS; EPIDEMIOLOGY; POPULATION;
D O I
10.1016/j.jhin.2017.11.011
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Studies often ignore time-varying confounding or may use inappropriate methodology to adjust for time-varying confounding. Aim: To estimate the effect of intensive care unit (ICU)-acquired bacteraemia on ICU mortality and discharge using appropriate methodology. Methods: Marginal structural models with inverse probability weighting were used to estimate the ICU mortality and discharge associated with ICU-acquired bacteraemia among patients who stayed more than two days at the general ICU of a London teaching hospital and remained bacteraemia-free during those first two days. For comparison, the same associations were evaluated with (i) a conventional Cox model, adjusting only for baseline confounders and (ii) a Cox model adjusting for baseline and time-varying confounders. Findings: Using the marginal structural model with inverse probability weighting, bacteraemia was associated with an increase in ICU mortality (cause-specific hazard ratio (CSHR): 1.29; 95% confidence interval (CI): 1.02-1.63)and a decrease in discharge (CSHR: 0.52; 95% CI: 0.45-0.60). By 60 days, among patients still in the ICU after two days and without prior bacteraemia, 8.0% of ICU deaths could be prevented by preventing all ICU-acquired bacteraemia cases. The conventional Cox model adjusting for time-varying confounders gave substantially different results [for ICU mortality, CSHR: 1.08 (95% CI: 0.88-1.32); for discharge, CSHR: 0.68 (95% CI: 0.60-0.77)]. Conclusion: In this study, even after adjusting for the timing of acquiring bacteraemia and time-varying confounding using inverse probability weighting for marginal structural
引用
收藏
页码:42 / 47
页数:6
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