Critical Care

, 16:P38 | Cite as

Severe community-acquired pneumonia: risk factors for in-hospital mortality

  • JM Pereira
  • JA Paiva
  • JP Baptista
  • F Froes
  • J Gonçalves-Pereira
Poster presentation
  • 650 Downloads

Keywords

Influenza Septic Shock Hospital Mortality Macrolide Receive Combination Therapy 

Introduction

Severe community-acquired pneumonia (SCAP) is an important cause of hospital mortality. The goal of this study was to identify variables associated with increased risk of in-hospital mortality at ICU admission.

Methods

A prospective, multicentre, observational cohort study of all patients with SCAP consecutively admitted to 15 Portuguese ICUs during a 12-month period. Demographic characteristics, co-morbidities, general severity scores (SAPS II, SAPS3, total SOFA), microbiological data and initial empirical antibiotherapy were recorded. Logistic regression analysis was performed to identify predictors of in-hospital mortality.

Results

A total of 505 (14%) of the 3,572 enrolled patients had SCAP, mostly male (66%) with a median age 58 (29 to 82). Median general severity scores were: SAPS II 44 (21 to 80), SAPS3 65 (41 to 98) and total SOFA 8 (3 to 17). Comorbidities were present in 74% of the patients and the most frequent were: diabetes mellitus (22%), chronic respiratory failure (18%) and alcoholism (15%). Median Charlson's comorbidity index was 4 (0 to 13). At ICU admission, 44% of SCAP patients had septic shock. Thirty-seven per cent of the cases were microbiologically documented (St. pneumoniae - 24%; influenza A (H1N1) virus - 20%; Enterobacteriaceae - 18%) and 12% had secondary bacteremia. Antibiotics were administered in the first 3 hours after hospital admission in 71% of the patients and 76% of them received combination therapy. Antibiotherapy was appropriate in 80% with a median duration of 8 days. Median ICU and hospital lengths of stay were 10 and 19 days respectively. Median ICU and hospital mortalities were 25% and 34% respectively. Variables independently associated with hospital mortality were: SAPS II score (OR 1.06; 95% CI 1.037 to 1.086), severe sepsis (OR 3.61; 95% CI 1.334 to 9.791), septic shock (OR 4.25; 95% CI 1.61 to 11.194), inappropriate antibiotherapy (OR 5.06; 95% CI 1.766 to 14.516) and the use of a macrolide (OR 0.40; 95% CI 0.203 to 0.809).

Conclusion

Disease severity evaluated by SAPS II and sepsis staging score and inappropriate initial antibiotherapy were independent risk factors for in-hospital mortality. The use of a macrolide was independently associated with a reduced risk of death.

Copyright information

© Pereira et al.; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Authors and Affiliations

  • JM Pereira
    • 1
  • JA Paiva
    • 1
  • JP Baptista
    • 2
  • F Froes
    • 3
  • J Gonçalves-Pereira
    • 4
  1. 1.Centro Hospitalar S. JoãoPortoPortugal
  2. 2.Hospitais Universidade CoimbraPortugal
  3. 3.Hospital Pulido Valente - CHLNLisbonPortugal
  4. 4.Hospital S. Francisco XavierLisbonPortugal

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