Association of Hematocrit and Albumin Difference With Ventilator-Associated Pneumonia in Patients With Continuous Mechanical Ventilation: Evidence From MIMIC-IV Database

TL;DR

This study finds that a higher difference between hematocrit and albumin levels is linked to a greater risk of ventilator-associated pneumonia in patients on continuous mechanical ventilation.

Contribution

The study identifies HCT-ALB as a novel, easily measurable predictor of ventilator-associated pneumonia risk.

Findings

HCT-ALB ≥ 5.30 was associated with a 1.36 increased odds of VAP compared to HCT-ALB < −1.10.

The predictive ability of HCT-ALB for VAP was moderate according to the ROC curve analysis.

The association remained robust across several patient subgroups.

Abstract

This study aims to investigate the relationship between the difference in hematocrit and albumin (HCT-ALB) and ventilator-associated pneumonia (VAP) among patients undergoing continuous mechanical ventilation.

This research utilized the data from the Medical Information Mart for Intensive Care IV database. The primary outcome was VAP occurred. HCT-ALB levels were divided into three groups according to the quantile: < −1.10; −1.10–5.30; ≥ 5.30. All patients with continuous mechanical ventilation were categorized into two groups: those who developed VAP and those who did not. Univariate and multivariate logistic regression analyses were used to assess the relationship between HCT-ALB and VAP risk. Receiver operating characteristic (ROC) curves were used to evaluate the predictive ability. To further assess the robustness of the findings, subgroup analyses were performed.

In our study, a total of 3021 patients were enrolled, and among them, 361 patients experienced VAP. Multivariate logistic regression showed that taking HCT-ALB < −1.10 as reference, HCT-ALB ≥ 5.30 was linked to an increased risk of VAP in patients undergoing continuous mechanical ventilation (odds ratio = 1.36, 95% confidence interval: 1.02–1.81). The ROC curve demonstrated approximately moderate predictive ability. This association remained robust in subgroups of male, quick Sepsis-Related Organ Failure Assessment score ≤ 2, not using antibiotics, having oral care, and no history of trauma injury, chronic obstructive pulmonary disease, or respiratory failure.

HCT-ALB, as an easily measurable indicator, was associated with the risk of VAP in patients with continuous mechanical ventilation.

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