Outcomes and Prognostic Factors for Severe Community-Acquired Pneumonia that Requires Mechanical Ventilation.
10.3904/kjim.2007.22.3.157
- Author:
Jin Hwa LEE
1
;
Yon Ju RYU
;
Eun Mi CHUN
;
Jung Hyun CHANG
Author Information
1. Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. jinhwalee@ewha.ac.kr
- Publication Type:Original Article
- Keywords:
APACHE;
Hypercapnia;
Mechanical ventilation;
Mortality;
Pneumonia
- MeSH:
Aged;
Aged, 80 and over;
Community-Acquired Infections/complications/mortality/therapy;
Female;
Hospital Mortality;
Humans;
Hypercapnia;
Male;
Middle Aged;
Pneumonia, Bacterial/complications/*diagnosis/*mortality/therapy;
Predictive Value of Tests;
Prognosis;
Respiration, Artificial;
Respiratory Insufficiency/*diagnosis/etiology/*mortality/therapy;
Retrospective Studies;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2007;22(3):157-163
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation. METHODS: We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003. RESULTS: The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16). CONCLUSIONS: Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.
