Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure - 02/06/26
, Maxens Decavèle a, b, Sangeeta Mehta c, Philippe R. Bauer d, Victoria Metaxa e, Frédéric Pène f, Christophe Girault g, Laveena Munshi c, Fabio Silvio Taccone h, Massimo Antonelli i, Francois Barbier j, Andreas Barratt-Due k, Gaston Burghi l, Emmanuel Canet m, Achille Kouatchet n, Virginie Lemiale o, Ignacio Martin-Loeches p, Djamel Mokart q, Anne-Sophie Moreau r, Luca Montini i, s, Peter Pickkers t, Jordi Rello u, v, w, Peter Schellongowski x, Nicolas Terzi y, Miia Valkonen z, Andry van de Louw aa, Elie Azoulay o, ab, Michael Darmon o, ab, acfor the Efraim investigators and the Nine-I study group
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Abstract |
Background |
Acute hypoxemic respiratory failure (AHRF) is the leading cause of intensive care unit (ICU) admission in immunocompromised patients, in whom both intubation and mortality rates are higher than in the general ICU population. This study explores dyspnea on admission as it relates to clinical outcomes.
Methods |
Secondary analysis of the Efraim study, a prospective multinational cohort study of immunocompromised patients with AHRF admitted to the ICU. Dyspnea was quantified by a numeric rating scale (dyspnea-NRS) from zero to 10. Factors associated with dyspnea-NRS were assessed with linear regression. Hierarchical model was used to assess factors independently associated with invasive mechanical ventilation (intubation) and hospital mortality.
Results |
547 patients were included. On ICU admission, median dyspnea-NRS was 5 (interquartile range 4–7). Variables independently associated with dyspnea-NRS were underlying immune defect unrelated to hematological malignancy, chronic heart failure, high SOFA score and respiratory rate. Intubation rate was 41 %. Variables independently associated with intubation were dyspnea-NRS ≥5 (odds ratio [OR] 2.61, p < 0.001), high SOFA (OR per point 1.10, p = 0.006) and fungal infection (OR 2.02, p = 0.020)., while respiratory rate and PaO 2 /FiO 2 were not. Hospital mortality was 37 %. Variables independently associated with hospital mortality were age (OR per year 1.02, P = 0.009), SOFA score (OR per point, 1.13, P < 0.001) and dyspnea-NRS (OR per point 1.19, P < 0.001).
Conclusions |
In immunocompromised patients admitted to the ICU for AHRF, dyspnea at admission is moderate to severe and is associated with clinical outcomes. Dyspnea-NRS ≥5 is associated with an increase in intubation rate and hospital mortality.
Le texte complet de cet article est disponible en PDF.Keywords : Immunocompromised, High flow oxygen, Non-invasive ventilation, Mechanical ventilation, Acute respiratory failure, Dyspnea, Comfort, Intubation, Diagnosis, Outcome.
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Vol 16
Article 100091- 2026 Retour au numéro
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