Estimation de la mortalité attribuable aux infections nosocomiales en réanimation : prise en compte de l'évolution de la gravité des patients en réanimation

Abstract : The estimation of the over-risk of death associated with nosocomial infection is difficult because of the inaccuracy of the definition used, a numerous of confounding factors and competing events. We discussed data available in the literature concerning the over-risk of death associated with ICU-acquired nosocomial pneumonia. We have shown that the risk estimation is highly variable and described the reasons for such variability. The target of our work was to take into account the severity on admission and the evolution of the severity as confounding factor of the relationship between nosocomial infection and death. We have shown that, independently of severity scores on admission, patients with the worst evolution have an increased risk of nosocomial infection and of mortality. In an attempt to adjust on these confounding factors we validate the accuracy of LOD and SOFA scores measured during the ICU stay. We also built a new score named TRIO based on severity on admission and evolution of the severity during the first 3 days particularly adapted to the population exposed to nosocomial infections. We used these tools in various examples using various statistical methods (exposed-unexposed studies with marginal Cox model with timedependent covariates or conditionallogistic regression). Finally, we briefly described the statistical tools able to improve the measurement of the risk estimations.
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Jean-François Timsit. Estimation de la mortalité attribuable aux infections nosocomiales en réanimation : prise en compte de l'évolution de la gravité des patients en réanimation. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2003. Français. ⟨NNT : 2003NAN11312⟩. ⟨tel-01748097⟩

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