Influenza and associated co-infections in critically ill immunosuppressed patients

Ignacio Martin-Loeches, Virginie Lemiale, Pierce Geoghegan, Mary Aisling McMahon, Peter Pickkers, Marcio Soares, Anders Perner, Tine Sylvest Meyhoff, Ramin Brandt Bukan, Jordi Rello, Philippe R. Bauer, Andry Van De Louw, Fabio Silvio Taccone, Jorge Salluh, Pleun Hemelaar, Peter Schellongowski, Katerina Rusinova, Nicolas Terzi, Sangeeta Mehta, Massimo AntonelliAchille Kouatchet, Pål Klepstad, Miia Valkonen, Precious Pearl Landburg, Andreas Barratt-Due, Fabrice Bruneel, Frédéric Pène, Victoria Metaxa, Anne Sophie Moreau, Virginie Souppart, Gaston Burghi, Christophe Girault, Ulysses V.A. Silva, Luca Montini, Francois Barbier, Lene B. Nielsen, Benjamin Gaborit, Djamel Mokart, Sylvie Chevret, Elie Azoulay

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: It is unclear whether influenza infection and associated co-infection are associated with patient-important outcomes in critically ill immunocompromised patients with acute respiratory failure. Methods: Preplanned secondary analysis of EFRAIM, a prospective cohort study of 68 hospitals in 16 countries. We included 1611 patients aged 18 years or older with non-AIDS-related immunocompromise, who were admitted to the ICU with acute hypoxemic respiratory failure. The main exposure of interest was influenza infection status. The primary outcome of interest was all-cause hospital mortality, and secondary outcomes ICU length of stay (LOS) and 90-day mortality. Results: Influenza infection status was categorized into four groups: patients with influenza alone (n = 95, 5.8%), patients with influenza plus pulmonary co-infection (n = 58, 3.6%), patients with non-influenza pulmonary infection (n = 820, 50.9%), and patients without pulmonary infection (n = 638, 39.6%). Influenza infection status was associated with a requirement for intubation and with LOS in ICU (P < 0.001). Patients with influenza plus co-infection had the highest rates of intubation and longest ICU LOS. On crude analysis, influenza infection status was associated with ICU mortality (P < 0.001) but not hospital mortality (P = 0.09). Patients with influenza plus co-infection and patients with non-influenza infection alone had similar ICU mortality (41% and 37% respectively) that was higher than patients with influenza alone or those without infection (33% and 26% respectively). A propensity score-matched analysis did not show a difference in hospital mortality attributable to influenza infection (OR = 1.01, 95%CI 0.90-1.13, P = 0.85). Age, severity scores, ARDS, and performance status were all associated with ICU, hospital, and 90-day mortality. Conclusions: Category of infectious etiology of respiratory failure (influenza, non-influenza, influenza plus co-infection, and non-infectious) was associated with ICU but not hospital mortality. In a propensity score-matched analysis, influenza infection was not associated with the primary outcome of hospital mortality. Overall, influenza infection alone may not be an independent risk factor for hospital mortality in immunosuppressed patients.

Original languageEnglish (US)
Article number152
JournalCritical Care
Issue number1
StatePublished - May 2 2019

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine


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