Table 1.
Patient characteristics and results on central line-associated bloodstream infection (CLABSI) in 672 ICU patients with and without COVID-19
| A | B | p value A vs B |
C COVID-19 |
D COVID-19 |
p value C vs D |
E COVID-19 |
F COVID-19 |
p value E vs F |
|
|---|---|---|---|---|---|---|---|---|---|
| Non-COVID-19 | COVID-19 | No dexamethasone | With dexamethasone | Dexamethasone only | Dexamethasone with interleukin antagonist | ||||
| Number of patients | 446 | 226 | 51 | 175 | 60 | 115 | |||
| Male (%) | 298 (66.8%) | 157 (69.5%) | 0.5411 | 36 (71%) | 121 (69%) | 1.0001 | 50 (83%) | 71 (62%) | 0.0031 |
| Mean age (SD) | 63 (13.6) | 60.1 (11.1) | 0.0032 | 61.9 (10.1) | 59.6 (11.3) | 0.1962 | 60.9 (10.4) | 58.9 (11.77) | 0.2672 |
| Mean APACHE IV score (SD) | 85.8 (28.8) | 63.5 (17.9) | < 0.0012 | 63.5 (17.5) | 63.6 (18.1) | 0.9942 | 62.9 (16) | 63.9 (19.3) | 0.7592 |
| Standardized mortality ratio (4) | 0.7 | 1.02 | 1.03 | 1.02 | 1.13 | 0.96 | |||
| Median ICU length-of stay (days, IQR) | 4.5 (3–9) | 12 (6–24) | < 0.0013 | 16 (6–26) | 11 (6–22) | 0.4353 | 11 (6–25) | 11 (6–22) | 0.9743 |
| Median hospital length-of-stay (days, IQR) | 16 (9–29) | 21 (11–35) | 0.0013 | 23 (11–38) | 21 (12–33) | 0.5243 | 18.5 (11–32) | 22 (13–34) | 0.4653 |
| ICU mortality | 88 (20%) | 62 (27%) | 0.0311 | 14 (28%) | 48 (27%) | 1.0001 | 21 (35%) | 27 (24%) | 0.1121 |
| Hospital mortality | 122 (27%) | 68 (30%) | 0.4151 | 14 (28%) | 54 (31%) | 0.7291 | 24 (40%) | 30 (27%) | 0.0851 |
| Number of central lines | 701 | 480 | 101 | 379 | 148 | 231 | |||
| Femoral/Jugular/Subclavian/PICC/Other | 79/581/5/33/3 | 83/389/2/6/0 | < 0.0015 | 19/81/0/1/0 | 64/308/2/5/0 | 0.8535 | 33/114/1/0/0 | 31/194/1/5/0 | 0.0455 |
| Central line days | 4009 | 3841 | 964 | 2877 | 1071 | 1806 | |||
| Median number of lines/patient (IQR) | 1 (1–2) | 1 (1–3) | < 0.0013 | 2 (1–2) | 1 (1–3) | 0.8323 | 2 (1–3) | 1 (1–2) | 0.1393 |
| Median number of line days per patient (IQR) | 5 (3–9) | 11.5 (6–24) | < 0.0013 | 14 (6–30) | 11 (6–22) | 0.1773 | 11 (4–25) | 10 (6–20) | 0.8763 |
| Median insertion time/line (days, IQR) | 4 (3–7) | 7 (4–10) | < 0.0013 | 9 (5–13) | 7 (4–10) | < 0.0013 | 6 (4–9) | 7 (4–10) | 0.4683 |
| Number of CLABSI (% of patients with CLABSI) | 8 (2%) | 24 (11%) | < 0.0011 | 2 (4%) | 22 (13%) | 0.1181 | 8 (13%) | 14 (12%) | 0.8141 |
| CLABSI/100 lines (95% CI) | 1.14 (0.35–1.93) | 5 (3.05–6.95) | < 0.00011 | 1.98 (0–4.70) | 5.8 (3.45–8.16) | 0.1951 | 5.41 (1.76–9.05) | 6.06 (2.98–9.14) | 1.0001 |
| CLABSI/1000 line days (95% CI) | 1.99 (0.61–3.38) | 6.25 (3.76–8.74) | 0.00391 | 2.07 (0–4.95) | 7.65 (4.46–10.83) | 0.061 | 7.47 (2.31–12.63) | 7.75 (3.71–11.80) | 1.0001 |
| CNS / enterococci / both | 5/3/0 | 15/6/3 | 0.5135 | 2/0/0 | 13/6/3 | 0.525 | 7/1/0 | 6/5/3 | 0.1095 |
| Femoral/Jugular/Subclavian/PICC/Other | 0/8/0/0/0 | 2/22/0/0/0 | 0.3995 | 0/2/0/0/0/ | 2/20/0/0/0 | 0.6565 | 1/7/0/0/0 | 1/13/0/0/0 | 0.6745 |
| Median days until CLABSI (IQR) | 7.5 (7–9) | 8.5 (6–11) | 0.5643 | 13.5 (10–17) | 7.5 (6–11) | 0.1163 | 9 (7–13) | 7 (5–10) | 0.1653 |
Patients with COVID-19 were further analyzed with regard to treatment with dexamethasone or not and with regard to treatment with interleukin antagonists (tocilizumab, sarilumab, or anakinra). The table illustrates that CLABSI incidence increases when dexamethasone is added with or without interleukin antagonists. Results are presented as mean (standard deviation) or median (interquartile range) as appropriate
APACHE IV, acute physiology and chronic health evaluation IV; CI, confidence interval; CLABSI, central line-associated bloodstream infection; CNS, coagulase negative staphylococci; COVID-19, coronavirus disease 2019; ICU, intensive care unit; IQR, interquartile range; PICC, peripherally inserted central catheter; SD, standard deviation
1Fisher’s exact test
2Student’s t test
3Mann–Whitney U test
4Standardized mortality ratio = observed mortality/expected mortality according to the APACHE IV model. APACHE IV scores and SMR are not valid for patients admitted from other hospitals or discharged to other hospitals, these patients were excluded for this calculation
5Chi-square test