Healthcare-associated pneumonia (HAP)
Risk of symptomatic infection and duration of disease
Healthcare-associated pneumonia (HAP) was defined in accordance with the ECDC case definition (ECDC, 2012). A systematic review of the literature was performed to estimate the sequelae and the probability of developing these sequelae following HAP. This review took into consideration the role of co-morbidities by estimating the attributable impact of HAP: attributable mortality, attributable risk of developing sequelae and its duration (effect on the length of hospital stay).
The extracted literature was limited to ventilator-associated pneumonia (VAP) because no specific literature was found for the more general search terms 'pneumonia' and 'lower respiratory tract infection'.
Attributable ICU mortality due to VAP varied from 0.1% to 9% based on the studies by Aybar Türkoglu et al. (2008) and Rello et al. (2002). The report on surveillance of healthcare-associated infections in intensive care units in Europe, 2008-2012, stemming from the HAI-Net ICU surveillance (ECDC, 2016), found an overall attributable case fatality proportion for pneumonia patients of 3.5% that was used as the median estimate in our model.
Attributable length of stay in an intensive care unit (ICU) due to VAP varied from 2.03 to 7 days whereas attributable length of hospital stay following VAP varied from 7 to 11.5 days. The latter range is included in the outcome tree (Aybar-Türkoglu, 2008; Rello, 2002).
Sepsis and acute respiratory distress syndrome (ARDS) are generally considered to be frequent consequences of VAP. However, only one study provided data on the transitional probability which amounted to 39% (proportion of patients suffering from severe sepsis and/or septic shock) for sepsis/ARDS as a health consequence of VAP (Damas, 2011). Duration of severe sepsis or septic shock was 9.9–13 days (Olaechea, 2013; Renaud, 2001). The long-term health outcomes following sepsis and ARDS were taken from the model developed for healthcare-associated primary bloodstream infection.
Model input summary
Table 1. Transition probabilities used in the outcome tree
Health outcome |
Distribution of health states in health outcome |
Transition probability |
Source/assumption |
Fatal cases following symptomatic infection |
|
3.5% (0.1-9%) |
Aybar Türkoglu, 2008; Rello, 2002; ECDC, 2016 |
Severe sepsis or septic shock |
|
39% |
Damas, 2011 |
Post-traumatic stress disorder (PTSD) following severe sepsis or septic shock |
|
13-21% |
Kessler, 1995; Deja, 2006; Schelling, 1998; Stoll, 1999; Kapfhammer, 2004; Hopkins, 2005 |
Cognitive impairment following severe sepsis or septic shock |
|
11-47% |
Hopkins, 2005; Iwashyna, 2010 |
Physical impairment following severe sepsis or septic shock |
|
100% |
Hopkins, 2005; Herridge, 2003; Hofhuis, 2008 |
Renal failure and renal replacement therapy following severe sepsis or septic shock |
|
0.9-1.3% |
Gallagher, 2014; Wisplinghoff, 2004 |
Table 2. Disability weights and duration
Health outcome |
Disability Weight (DW) (Haagsma, 2015) |
Duration |
||
DW |
Label |
In years |
Source/assumption |
|
Symptomatic infection |
0.125 (0.104-0.152) |
Infectious disease, acute episode, severe |
0.019-0.031 |
Aybar Türkoglu, 2008; Rello, 2002 |
Severe sepsis or septic shock |
0.655 (0.579-0.727) |
Intensive care unit admission |
0.027-0.036 |
Olaechea, 2013; Renaud, 2001 |
Post-traumatic stress disorder (PTSD) following severe sepsis or septic shock |
0.088 (0.07-0.108) |
Subacute sclerosing panencephalitis – phase 1 (chosen according to best fitting description) |
Remaining life expectancy |
|
Cognitive impairment following severe sepsis or septic shock |
0.043 (0.026-0.064) |
Intellectual disability, mild |
Remaining life expectancy |
|
Physical impairment following severe sepsis or septic shock |
0.011-0.053 |
Range between motor impairment, mild and motor impairment, moderate |
Remaining life expectancy |
|
Renal failure and renal replacement therapy following severe sepsis or septic shock |
0.030-0.487 |
Range between end-stage renal disease, on dialysis and end-stage renal disease, with kidney transplant |
Remaining life expectancy |
|
References
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