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Outcomes With Severe Blastomycosis and Respiratory Failure in the United States
Barret Rush1, Sylvain Lother1, Bojan Paunovic1
1Division of Critical Care Medicine, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Background:
Outcomes of patients with severe pulmonary blastomycosis requiring mechanical ventilation (MV) are not well understood in the modern era. Limited historical case series reported 50-90% mortality in patients with acute respiratory distress syndrome caused by blastomycosis. The objective of this large retrospective cohort study was to describe the risk factors and outcomes of patients with severe pulmonary blastomycosis.
Methods:
We performed a retrospective cohort analysis utilizing the Nationwide Inpatient Sample from 2006-2014. Patients aged >18 years with a diagnosis of blastomycosis who received MV were included.
Results:
There were 1848 patients with a diagnosis of blastomycosis included in the study. Of these, 219 (11.9%) underwent MV with a mortality rate of 39.7% compared with 2.5% in patients not requiring ventilatory support (P < .01). The median (IQR) time to death for patients requiring MV was 12 (8-16) days. The median length of hospital stay for survivors of MV was 22 (14-37) days. The rate of MV was higher for patients treated in teaching hospitals (63.4% vs 57.2%, P = .05) and lower for those receiving care at a rural hospital (12.3% vs 17.2%, P = .04). In a multivariate model, female gender was associated with increased risk of mortality (OR, 1.84; 95% CI, 1.06-3.20; P = .03) as was increasing patient age (10-year age increase OR, 1.64; 95% CI, 1.33-2.02; P < .01).
Conclusions:
In the largest published cohort of patients with blastomycosis, mortality for patients on MV is high at ~40%, 16-fold higher than those without MV.
Insights
Severe pulmonary blastomycosis requiring mechanical ventilation (MV) has a high mortality rate of approximately 40%. This outcome is 16 times higher than for patients not needing MV, highlighting critical care needs.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Outcomes for severe pulmonary blastomycosis requiring mechanical ventilation (MV) are poorly understood in the current medical era.
- Historical data indicate high mortality rates (50-90%) for blastomycosis-induced acute respiratory distress syndrome.
- This study addresses the knowledge gap regarding risk factors and outcomes in patients with severe pulmonary blastomycosis needing MV.
Purpose of the Study:
- To describe the risk factors associated with severe pulmonary blastomycosis.
- To determine the outcomes for patients with severe pulmonary blastomycosis requiring mechanical ventilation.
- To analyze mortality rates and length of hospital stay in this patient population.
Main Methods:
- Retrospective cohort analysis of the Nationwide Inpatient Sample (NIS) database from 2006 to 2014.
- Inclusion criteria: patients over 18 years old diagnosed with blastomycosis who received mechanical ventilation.
- Statistical analysis included multivariate modeling to identify risk factors for mortality.
Main Results:
- A total of 1848 blastomycosis patients were analyzed; 219 (11.9%) required MV.
- Mortality was significantly higher in patients on MV (39.7%) compared to those not requiring MV (2.5%, P < .01).
- Female gender and increasing patient age were associated with increased mortality risk in a multivariate model.
Conclusions:
- Mortality for patients with blastomycosis requiring mechanical ventilation remains high at approximately 40% in this large cohort.
- Patients on MV experienced a mortality rate 16 times higher than those not requiring ventilatory support.
- Findings underscore the severity of pulmonary blastomycosis requiring advanced respiratory support.
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