title: Attributable mortality of ventilator-associated pneumonia.
abstract: OBJECTIVE
  To critically discuss the attributable mortality of ventilator-associated pneumonia (VAP) and potential sources of variation.
  
  
  RESULTS
  The review will cover the available estimates (0-50%). It will also explore the source of variation because of definition of VAP (being lower if inaccurate), case-mix issues (being lower for trauma patients), the severity of underlying illnesses (being maximal when the severity of underlying illness is intermediate), and on the characteristics and the severity of the VAP episode. Another important source of variation is the use of poorly appropriate statistical models (estimates biased by lead time bias and competing events). New extensions of survival models which take into account the time dependence of VAP occurrence and competing risks allow less biased estimation as compared with traditional models.
  
  
  CONCLUSIONS
  Attributable mortality of VAP is about 6%. Accurate diagnostic methods are key to properly estimating it. Traditional statistical models should no longer be used to estimate it. Prevention efforts targeted on patients with intermediate severity may result in the most important outcome benefits.
authors.affiliation: EA 11, Albert Bonniot Institute U823, Joseph Fourier University, Paris, France. jftimsit@chu-grenoble.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000401:mortality*; D016019:Survival Analysis