Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome

Table 1 Etiologic agents of ventilator-associated pneumonia

Microorganism	Total (n = 18)
Klebsiella pneumonia	5/18 (28%)
Escherichia coli	5/18 (28%)
Klebsiella oxytoca	2/18 (11%)
Enterobacter spp.	1/18 (6%)
Citrobacter spp.	1/18 (6%)
Pseudomonas aeruginosa	8/18 (44%)
Staphylococcus aureus	4/18 (22%)
Corynebacterium striatum	4/18 (22%)
Xantomonas spp.	2/18 (11%)
Acinetobacter spp.	2/18 (11%)

The Enterobacteriaceae are written in bold. Note that in some patients more than one microorganism was found.

Table 2 Preoperative, intraoperative and postoperative variables

Variable	Patients in study (n = 242)	VAP-yes (n = 18)	VAP-no (n = 224)	P-value
Age (yr)	56 (19-69)	55 (37-66)	56 (19-69)	0.624
Weight (kg)	72 (39-106)	73 (47-93)	72 (39-106)	0.515
Height (cm)	170 (148-193)	169 (155-182)	170 (148-193)	0.495
BMI (kg/m2)	25 (16-38)	24 (19-34)	25 (16-38)	0.452
BSA (m2)	1.9 (1.3-2.3)	1.9 (1.4-2.1)	1.9 (1.3-2.3)	0.505
HCV+	128 (53%)	8 (44%)	120 (54%)	0.455
HBV+	49 (20%)	3 (17%)	46 (21%)	0.486
Alcohol abuse	37 (15%)	3 (17%)	34 (15%)	0.540
HCC	118 (49%)	4 (22%)	114 (51%)	0.019
MELD score	21 (6-48)	23 (14-48)	20 (6-45)	0.032
CTP score	11 (5-15)	11 (9-14)	11 (5-15)	0.060
Bilirubin (mg/dL)	5.9 (0.4-71.1)	8.0 (2.1-71.1)	5.6 (0.4-68.6)	0.054
Creatinine (mg/dL)	1.0 (0.0-5.2)	1.1 (0.5-5.2)	1.0 (0.0-4.9)	0.708
INR	1.6 (0.8-7.6)	1.9 (1.3-3.8)	1.6 (0.8-7.6)	0.020
HbA1c (%)	10.8 (4.5-17)	9.9 (8.1-14.9)	10.9 (4.5-17)	0.085
Urea (mg/dL)	0.3 (0.1-3.1)	0.3 (0.1-2.6)	0.3 (0.1-3.1)	0.554
Serum glucose (mg/dL)	105 (60-358)	102 (63-284)	105 (60-358)	0.369
Albumin (g/dL)	3.5 (2.0-5.3)	3.3 (2.6-4.5)	3.5 (2.0-5.3)	0.189
TIPS presence	15 (6%)	1 (6%)	14 (6%)	0.691
Furosemide therapy	144 (60%)	11 (61%)	133 (59%)	0.885
Canrenoate therapy	112 (46%)	5 (28%)	107 (48%)	0.102
Terlipressin therapy	20 (8.3%)	7 (39%)	13 (5.8%)	< 0.001
Preoperative hospital stay	82 (34%)	11 (61%)	71 (32%)	0.018
Intraoperative and postoperative variables
Length of surgery (min)	560 (512-650)	570 (490-630)	580 (460-660)	0.067
Anhepatic phase duration (min)	120 (88-138)	118 (85-138)	140 (116-145)	0.067
RBC transfusions (units)	8 (0-65)	16 (6-48)	7 (0-65)	< 0.05
FFP transfusions (units)	9 (0-75)	10 (0-31)	9 (0-35)	0.122
Platelet transfusions (units)	2 (0-4)	2 (1-3)	2 (1-3)	0.587
CIT (h)	7 (6-9)	7 (7-9)	8 (7-9)	0.354
Pre-reperfusion VP infusion	68 (28%)	8 (22%)	60 (26%)	0.530
Post-reperfusion VP bolus	110 (45%)	8 (44%)	102 (45%)	0.520
Post-reperfusion VP infusion	118 (48%)	10 (55%)	108 (48%)	0.510
Duration of ICU stay (d)	5 (3-10)	16 (20-59)	5 (3-8)	< 0.05
Hospital mortality	14 (6%)	4 (22%)	10 (4%)	< 0.05
Median duration of MV (d)	0.42 (0.208-0.417)	1.125 (0.375-11.75)	0.38 (0.208-0.864)	< 0.05
Time between intubation and VAP insurgence (h)	-	72 (48-336)	-	-

Statistical analyses were performed using parametric tests and nonparametric tests (Wilcoxon’s rank sum) when normality or variance assumptions were not met. Proportions were compared by Fisher’s test. Statistical significance was defined as P < 0.05. HCV: Hepatitis C virus; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; BMI: Body mass index; BSA: Body surface; MELD: Model for end-stage liver disease; CTP: Child-Turcotte-Pugh; INR: International normalized ratio; HbA1c: Glycated hemoglobin; TIPS: Trans-jugular intrahepatic porto-sistemicity shunt; RBC: Packed red blood cells; FFP: Fresh frozen plasma; CIT: Cold ischemia time; VP: Vasopressor; ICU: Intensive care unit; MV: Mechanical ventilation; VAP: Ventilator-associated pneumonia.

Table 3 Donor variables n (%)

Variable	Patients in study (n = 242)	VAP-yes (n = 18)	VAP-no (n = 224)	P-value
Donor age (yr)	56 (14-89)	58 (20-86)	56 (19-80)	0.624
Donor gender (male)	182 (75)	14 (77)	168 (69)	0.624
Donor risk index > 1.8	52 (21)	4 (22)	48 (21)	0.345

VAP: Ventilator-associated pneumonia.

Table 4 Variables associated with ventilator-associated pneumonia in multivariate analysis

Variable	OR	95%CI	P-value
MELD score	0.98	0.8-10	0.670
CTP score	0.79	0.5-1.1	0.27
RBC transfusions (units)	1.1	1.04-1.1	< 0.001
MV (d)	1.10	1.03-1.15	< 0.001
Terlipressin therapy	31.49	4.7-49.2	< 0.001
Preoperative hospital stay (d)	1.8	1-1.9	< 0.05

Statistical significance was defined as P < 0.05. MELD: Model for end-stage liver disease; CTP: Child-Turcotte-Pugh; RBC: Packed red blood cells; MV: Mechanical ventilation.