Please use this identifier to cite or link to this item:
Title: Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients
Author: Ferrer, Manel
Travierso, Chiara
Cillóniz, Catia
Gabarrús, Albert
Ranzani, Otavio T.
Polverino, Eva
Liapikou, Adamantia
Blasi, Francesco
Torres Martí, Antoni
Keywords: Pneumònia
Respiració artificial
Artificial respiration
Issue Date: 25-Jan-2018
Publisher: Public Library of Science (PLoS)
Abstract: Background Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. Methods We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Results Among 3,719 patients hospitalized with CAP, 664 (18%) had criteria for SCAP, and 154 (23%) received IMV at presentation of pneumonia; 198 (30%) presented with septic shock. In 370 (56%) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33%, vs. 94, 18% respectively, p<0·001), and higher than that predicted by APACHE-II score (26%). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3·54, 95% confidence interval 1·45-8·37, p = 0·006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Conclusion Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.
Note: Reproducció del document publicat a:
It is part of: PLoS One, 2018, vol. 13, num. 1, p. e0191721
Related resource:
ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)
Articles publicats en revistes (Medicina)

Files in This Item:
File Description SizeFormat 
686144.pdf415.9 kBAdobe PDFView/Open

This item is licensed under a Creative Commons License Creative Commons