Impact of macrolide treatment on long-term mortality in patients admitted to the intensive care unit (ICU) due to community-acquired pneumonia (CAP): a targeted maximum likelihood estimation and survival analysis
Main finding · MortalityResult — go to the resultHazard ratio 0.69 95% CI 0.60–0.78Authors' conclusion
Macrolide-based treatment reduced the hazard risk of long-term mortality by almost one-third. This effect remains after simulating an RCT with TMLE and the sensitivity analysis for the HCAP classification.
Study context
- Population
- Patients aged 16 years or older admitted to the ICU due to CAP, MIMIC-IV database
- Participants
- 3,775 patients
- Exposure
- Macrolide-based vs non-macrolide-based treatment
- Macrolide-basedn = 1,154
- Non-macrolide-basedn = 2,621reference
- Outcome
- Long-term mortality
- Follow-up
- 6 and 12 months after hospital admission
Methodological detailsMIMIC-IV database, targeted maximum likelihood estimation, survival analysis, multivariate analysis, Sensitivity analysis excluding Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP)
- MIMIC-IV database
- Targeted maximum likelihood estimation
- Survival analysis
- Multivariate analysis
- Sensitivity analysis excluding Pseudomonas aeruginosa or MRSA pneumonia to control for HCAP
Main finding
Mortality · 6 months
Hazard ratio
0.69
95% CI 0.60–0.78
P < 0.001
Events by group
Macrolide-based
31.5
363 of 1154
Non-macrolide-based
39.5
1035 of 2621
Macrolide-based vs Non-macrolide-based
HR 0.69 (95% CI 0.60–0.78); P < 0.001
As reported in the abstract
- Targeted maximum likelihood estimation (TMLE) additive effect estimate (protective effect continued)
- - 0.069
Observational data: associations, not effects.
Further findings
| Outcome | Macrolide-based | Non-macrolide-based | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Mortality · 12 months | 39.0 | 45.7 | 0.72 (0.64–0.81) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Risk factors for long-term mortality
- Main risk factors: Charlson comorbidity index, SAPS II, septic shock, respiratory failure
Original publication
Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis. Crit Care. Published 31 May 2023. doi:10.
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