Table 3.
Relationship between category of PEEP level and outcomes in mechanically ventilated patients.
| Relative Risk Ratio | |||
|---|---|---|---|
| Still at risk | Dead | WRF | |
| Day 1 mechanical ventilation on day-3 WRF | |||
| Male gender | 0.93 [0.6;1.46], (p=0.766) | 0.5 [0.2;1.25], (p=0.139) | 1.05 [0.67;1.66], (p=0.819) |
| Afro-american origin | 1.16 [0.55;2.47], (p=0.7) | 0.55 [0.07;4.56], (p=0.576) | 1.19 [0.55;2.56], (p=0.658) |
| Age | |||
| ≤ 50y | ref. | ref. | ref. |
| ]50, 60] y | 0.96 [0.53;1.73], (p=0.891) | 2.06 [0.44;9.66], (p=0.36) | 0.97 [0.53;1.77], (p=0.91) |
| ]60, 70] y | 1.58 [0.81;3.07], (p=0.18) | 9.66 [2.38;39.13], (p=0.001) | 2.04 [1.04;4.02], (p=0.039) |
| > 70 | 2.14 [1.17;3.9], (p=0.013) | 12.61 [3.43;46.39], (p<0.001) | 3.12 [1.7;5.76], (p<0.001) |
| PEEP level (by 1 cmH2O increase) | 1.32 [1.13;1.55], (p=0.001) | 1.29 [1.03;1.61], (p=0.024) | 1.36 [1.16;1.6], (p<0.001) |
| SAPS 3 minus age (by 1 unit increase) | 1.01 [1;1.02], (p=0.235) | 1.04 [1.02;1.06], (p<0.001) | 1.01 [1;1.03], (p=0.035) |
| Sepsis Angus’ criteria | 2.7 [1.72;4.22], (p<0.001) | 0.3 [0.11;0.82], (p=0.02) | 1.63 [1.03;2.57], (p=0.036) |
| Charslon score (by 1 unit increase) | 1.1 [0.97;1.24], (p=0.145) | 0.81 [0.6;1.09], (p=0.163) | 1.15 [1.01;1.3], (p=0.03) |
| Use of nephrotoxic agents | 1.2 [0.69;2.08], (p=0.52) | 6.83 [1.39;33.54], (p=0.018) | 1.44 [0.82;2.53], (p=0.21) |
| Worst PaCO2 (by 5mmHg increase) | 0.99 [0.98;1.01], (p=0.23) | 0.99 [0.97;1.02], (p=0.468) | 0.99 [0.98;1], (p=0.196) |
| Worst PaO2/FiO2 ratio (by 10 units decrease) | 1 [1;1], (p=0.254) | 1 [0.99;1], (p=0.279) | 1 [1;1], (p=0.341) |
| Fluid balance, per 1000mL increase | 1.03 [0.97;1.09], (p=0.373) | 0.96 [0.85;1.09], (p=0.514) | 1.01 [0.95;1.08], (p=0.661) |
| Day 2 mechanical ventilation setting on day-4 WRF | |||
| Male gender | 0.51 [0.17;1.52], (p=0.224) | 0.41 [0.09;1.79], (p=0.234) | 0.49 [0.16;1.49], (p=0.209) |
| Afro-american origin | 0.51 [0.1;2.46], (p=0.397) | 1.3 [0.67;2.55], (p=0.438) | 1.1 [0.23;5.38], (p=0.902) |
| Age | |||
| ≤ 50y | ref. | ref. | ref. |
| ]50, 60] y | 2.34 [0.25;22.19], (p=0.459) | 0.62 [0.14;2.73], (p=0.53) | 2.15 [0.22;20.86], (p=0.508) |
| ]60, 70] y | 0.67 [0.15;3.11], (p=0.614) | 0.71 [0.23;2.14], (p=0.543) | 0.82 [0.17;3.87], (p=0.804) |
| > 70 | 0.73 [0.19;2.88], (p=0.654) | 0.87 [0.19;4.02], (p=0.863) | 0.95 [0.24;3.8], (p=0.937) |
| AKI at day-1 | 1.15 [0.39;3.39], (p=0.795) | 2.48 [0.51;12.06], (p=0.262) | 2.07 [0.69;6.16], (p=0.193) |
| PEEP level over day-1 and day-2 (by 1 cmH2O increase) | 1.22 [0.92;1.62], (p=0.175) | 1.13 [0.78;1.63], (p=0.524) | 1.17 [0.88;1.56], (p=0.279) |
| Vasopressor support | 41 [21;81], (p<0.001) | 0.97 [0.5;1.86], (p=0.926) | 2.2 [1.35;3.56], (p=0.001) |
| Charlson score | 0.96 [0.73;1.27], (p=0.784) | 0.89 [0.69;1.15], (p=0.381) | 1.01 [0.76;1.34], (p=0.962) |
| Reason for ICU admission | |||
| Digestive disease | 0.21 [0.04;1.2], (p=0.08) | 0 [0;0], (p<0.001) | 2.01 [1.68;2.4], (p<0.001) |
| Respiratory disease | 0.34 [0.11;1.03], (p=0.058) | 0.55 [0.11;2.64], (p=0.452) | 0.93 [0.49;1.75], (p=0.812) |
| Trauma | 0.2 [0.08;0.52], (p=0.001) | 0.11 [0.02;0.49], (p=0.004) | 0.5 [0.27;0.92], (p=0.025) |
| Others | 0.37 [0.13;1.04], (p=0.06) | 0.12 [0.02;0.7], (p=0.019) | 0.38 [0.2;0.7], (p=0.002) |
| Use of nephrotoxic agents | 0.87 [0.27;2.82], (p=0.812) | 1.6 [0.28;9.31], (p=0.598) | 1.06 [0.32;3.49], (p=0.93) |
| Worst PaCO2 (by 5mmHg increase) | 1.11 [0.87;1.41], (p=0.422) | 0.72 [0.47;1.1], (p=0.125) | 1.07 [0.83;1.36], (p=0.616) |
| Worst PaO2/FiO2 ratio (by 10 units decrease) | 1.01 [0.97;1.06], (p=0.642) | 0.98 [0.91;1.05], (p=0.525) | 1 [0.96;1.05], (p=0.976) |
| Cumulative fluid balance since ICU admission, per 1000mL increase | 1.08 [1.01;1.14], (p=0.015) | 1.06 [0.98;1.15], (p=0.147) | 1.07 [1.01;1.13], (p=0.031) |
Multivariable multinomial logistic regression. The relative risk ratio should be interpreted as the association of the level of PEEP and outcomes compared to a 1 cmH2O lower PEEP level and to the outcome reference class (i.e. to be discharged alive without AKI). The relative risk ratio of 1.16 for the PEEP level should be interpreted as follows: The risk of worsening renal function within day-3 relative to being discharged alive from the ICU was 1.16-fold higher by 1 cmH2O increase of the PEEP level in mechanically ventilated patients. WRF: worsening renal function; PEEP: positive end-expiratory pressure.