Critically ill immunocompromised patients requiring mechanical ventilation (MV) may be particularly vulnerable to ventilator-associated events (VAE), yet the impact of baseline immunosuppression on VAE incidence remains unclear. We conducted a secondary analysis of a cohort of adults requiring MV for ≥4 days in two ICUs of a tertiary hospital in Moscow, Russia. Using competing-risk regression, we compared the 30-day incidence of VAE between immunocompromised and non-immunocompromised patients. We then evaluated the association between VAE and 30-day ICU mortality among immunocompromised patients using Cox regression. Of 269 patients, 122 (45.4%) had baseline immunosuppression. The incidence of any VAE was higher in immunocompromised patients, though the estimate was imprecise (adjusted subhazard ratio aSHR 1.64; 95% CI 0.82–3.30); for infection-related ventilator-associated complications (IVAC), the estimate suggested a more than twofold increased hazard, but with considerable uncertainty (aSHR 2.22; 95% CI 0.85–5.78). In patients with immunosuppression, IVAC were associated with increased mortality (adjusted hazard ratio 2.38; 95% CI 1.16–4.89). Despite a higher estimated incidence of VAE in immunocompromised patients, we could not establish a clear association between baseline immunosuppression and VAE risk. IVAC were associated with increased mortality in immunocompromised patients, although this finding should be considered exploratory.
Vladimirov et al. (Tue,) studied this question.