Relationship Between Ventilator-Associated Pneumonia and Mortality in COVID-19 Patients

A Planned Ancillary Analysis of the coVAPid Cohort

Saad Nseir; Ignacio Martin-Loeches; Pedro Povoa; Matthieu Metzelard; Damien Du Cheyron; Fabien Lambiotte; Fabienne Tamion; Marie Labruyere; Demosthenes Makris; Claire Boulle Geronimi; Marc Pinetonde Chambrun; Martine Nyunga; Olivier Pouly; Bruno Mégarbane; Anastasia Saade; Gemma Gomà; Eleni Magira; Jean-François Llitjos; Antoni Torres; Iliana Ioannidou; Alexandre Pierre; Luis Coelho; Jean Reignier; Denis Garot; Louis Kreitmann; Jean-Luc Baudel; Guillaume Voiriot; Damien Contou; Alexandra Beurton; Pierre Asfar; Alexandre Boyer; Arnaud W. Thille; Armand Mekontso-Dessap; Vassiliki Tsolaki; Christophe Vinsonneau; Pierre-Edouard Floch; Loïc Le Guennec; Adrian Ceccato; Antonio Artigas; Mathilde Bouchereau; Julien Labreuche; Alain Duhamel; Anahita Rouzé


Crit Care. 2021;25(177) 

In This Article

Abstract and Introduction


Background: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients.

Methods: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event.

Findings: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16–2.47), p = 0.006), and influenza groups (1.75 (1.03–3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64–1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups.

Interpretation: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality.

Clinical Trial Registration: The study was registered at, number NCT04359693.