Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure
Year: 2026
Type: article
Abstract: Background Acute hypoxemic respiratory failure (AHRF) is the leading cause of intensive care unit (ICU) admission in immunocompromised patients, in whom both intubation and mortality rates are higher than in the general ICU population. This study explores dyspnea on admission as it relates to clinical outcomes. Methods Secondary analysis of the Efraim study, a prospective multinational cohort study of immunocompromised patients with AHRF admitted to the ICU. Dyspnea was quantified by a numeric rating scale (dyspnea-NRS) from zero to 10. Factors associated with dyspnea-NRS were assessed with linear regression. Hierarchical model was used to assess factors independently associated with invasive mechanical ventilation (intubation) and hospital mortality. Results 547 patients were included. On ICU admission, median dyspnea-NRS was 5 (interquartile range 4–7). Variables independently associated with dyspnea-NRS were underlying immune defect unrelated to hematological malignancy, chronic heart failure, high SOFA score and respiratory rate. Intubation rate was 41 %. Variables independently associated with intubation were dyspnea-NRS ≥5 (odds ratio [OR] 2.61, p < 0.001), high SOFA (OR per point 1.10, p = 0.006) and fungal infection (OR 2.02, p = 0.020)., while respiratory rate and PaO 2 /FiO 2 were not. Hospital mortality was 37 %. Variables independently associated with hospital mortality were age (OR per year 1.02, P = 0.009), SOFA score (OR per point, 1.13, P < 0.001) and dyspnea-NRS (OR per point 1.19, P < 0.001). Conclusions In immunocompromised patients admitted to the ICU for AHRF, dyspnea at admission is moderate to severe and is associated with clinical outcomes. Dyspnea-NRS ≥5 is associated with an increase in intubation rate and hospital mortality.
Source: Annals of Intensive Care
Authors: Alexandre Demoule, Maxens Decavèle, Sangeeta Mehta, Philippe R. Bauer, Victoria Metaxa, Frédéric Pène, Christophe Girault, Laveena Munshi, Fabio Silvio Taccone, Massimo Antonelli, Francois Barbier, Andreas Barratt-Due, Gaston Burghi, Emmanuel Canet, Achille Kouatchet, Virginie Lemiale, Ignacio Martin-Loeches, Djamel Mokart, Anne-Sophie Moreau, Luca Montini, Peter Pickkers, Jordi Rello, Peter Schellongowski, Nicolas Terzi, Miia Valkonen, Andry van de Louw, Elie Azoulay, Michael Darmon
Institutions: Inserm, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Neurophysiologie respiratoire expérimentale et clinique, University of Toronto, Sinai Health System, Mayo Clinic, King's College Hospital NHS Foundation Trust, King's College Hospital, Centre National de la Recherche Scientifique, Université Paris Cité, Hôpital Cochin, Institut Cochin, Université de Rouen Normandie, Université Libre de Bruxelles, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, Centre hospitalier universitaire d'Orléans, Oslo University Hospital, Hospital Maciel, Centre Hospitalier Universitaire de Nantes, Nantes Université, Centre Hospitalier Universitaire d'Angers, Hôpital Saint-Louis, Trinity College Dublin, Institut Paoli-Calmettes, Centre Hospitalier Universitaire de Lille, Università Cattolica del Sacro Cuore, Radboud University Medical Center, Instituto de Salud Carlos III, Universitat Internacional de Catalunya, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Vall d'Hebron Institut de Recerca, Medical University of Vienna, Centre Hospitalier Universitaire de Rennes, University of Helsinki, Helsinki University Hospital, Pennsylvania State University, Penn State Milton S. Hershey Medical Center, Institut de recherche Saint-Louis
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,490
Funders: Helsingin Yliopisto, Pennsylvania State University, Fondation du Souffle, Université Grenoble Alpes, Université de Lille, Københavns Universitet, Odense Universitetshospital, Centre Hospitalier Régional Universitaire de Montpellier, Syddansk Universitet, Institut Gustave-Roussy, Universitat Autònoma de Barcelona, Oslo universitetssykehus HF, Trinity College
OpenAlex ID: W7161679901