Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure
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.
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BibTeX
@article{demoule2026dyspnea,
title = {{Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure}},
author = {Alexandre Demoule and Maxens Decavèle and Sangeeta Mehta and Philippe R Bauer and Victoria Metaxa and Frédéric Pene and Christophe Girault and Laveena Munshi and Fabio Silvio Taccone and Massimo Antonelli and Jean Francois Barbier and Andreas Barratt-Due and Gaston Burghi and Emmanuel Canet and Achille Kouatchet and Virginie Lemiale and Ignacio Martin-Loeches and Djamel Mokart and Anne-Sophie Moreau and Luca Montini and Peter Pickkers and Jordi Rello and Peter Schellongowski and Nicolas Terzi and Miia Valkonen and Andry van de Louw and Elie Azoulay and Michaël Darmon},
journal = {Annals of Intensive Care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100091},
url = {https://hal.science/hal-05684087v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Dyspnea as a marker of prognosis in immunocompromised patients with acute respiratory failure
AU - Alexandre Demoule
AU - Maxens Decavèle
AU - Sangeeta Mehta
AU - Philippe R Bauer
AU - Victoria Metaxa
AU - Frédéric Pene
AU - Christophe Girault
AU - Laveena Munshi
AU - Fabio Silvio Taccone
AU - Massimo Antonelli
AU - Jean Francois Barbier
AU - Andreas Barratt-Due
AU - Gaston Burghi
AU - Emmanuel Canet
AU - Achille Kouatchet
AU - Virginie Lemiale
AU - Ignacio Martin-Loeches
AU - Djamel Mokart
AU - Anne-Sophie Moreau
AU - Luca Montini
AU - Peter Pickkers
AU - Jordi Rello
AU - Peter Schellongowski
AU - Nicolas Terzi
AU - Miia Valkonen
AU - Andry van de Louw
AU - Elie Azoulay
AU - Michaël Darmon
PY - 2026
DA - 2026/10/16
JO - Annals of Intensive Care
DO - 10.1016/j.aicoj.2026.100091
UR - https://hal.science/hal-05684087v1
AB - 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.
SN - 2110-5820
ER -