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http://hdl.handle.net/11054/53
Title: | Endotoxemia and mortality prediction in ICU and other settings: underlying risk and co-detection of gram negative bacteremia are confounders. |
Authors: | Hurley, James C. Guidet, Bertrand Offenstadt, Georges Maury, Eric |
Issue Date: | 2012 |
Publisher: | BioMed Central Ltd |
Place of publication: | London |
Publication Title: | Critcal Care |
Volume: | 16 |
Issue: | 4 |
Start Page: | R148 |
Abstract: | ABSTRACT: INTRODUCTION: The interdependence between endotoxemia, gram negative (GN) bacteremia and mortality has been extensively studied. Underlying patient risk and GN bacteremia types are possible confounders of the relationship. METHODS: Published studies with ≥10 patients in either ICU or non-ICU settings, endotoxemia detection by limulus assay, reporting mortality proportions and ≥1 GN bacteremia were included. Summary odds ratios (OR) for mortality were derived across all studies by meta-analysis for the following contrasts: sub-groups with either endotoxemia (group three), GN bacteremia (group two) or both (group one) each versus the group with neither detected (group four; reference group). The mortality proportion for group four is the proxy measure of study level risk within L'Abbé plots. RESULTS: Thirty-five studies were found. Among nine studies in an ICU setting, the OR for mortality was borderline (OR <2) or non-significantly increased for groups two (GN bacteremia alone) and three (endotoxemia alone) and patient group one (GN bacteremia and endotoxemia co-detected) each versus patient group four (neither endotoxemia nor GN bacteremia detected). The ORs were markedly higher for group one versus group four (OR 6.9; 95% confidence interval (CI), 4.4 -to 11.0 when derived from non-ICU studies. The distributions of Pseudomonas aeruginosa and Escherichia coli bacteremias among groups one versus two are significantly unequal. CONCLUSIONS: The co-detection of GN bacteremia and endotoxemia is predictive of increased mortality risk versus the detection of neither but only in studies undertaken in a non-ICU setting. Variation in GN bacteremia species types and underlying risk are likely unrecognized confounders in the individual studies. |
URI: | http://hdl.handle.net/11054/53 |
ISSN: | 1364-8535 |
Internal ID Number: | 00039 |
Health Subject: | GRAM NEGATIVE BACTEREMIA ENDOTOXEMIA ODDS RATIO META ANALYSIS L’ABBE PLOTS |
Type: | Journal Article Article |
Appears in Collections: | Research Output |
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