Impact of Cardiovascular Failure in Intensive CareUnit-Acquired Pneumonia: A Single-Center, Prospective Study.

Pierluigi Di Natale,Gianluigi Li Bassi,Antoni Torres,Stefano Nogas,Ignacio Martin-Loeches,Anna Motos,Francesco Idone,Otavio Ranzani,Marco Carbonara,Adrian Ceccato,Tarek Senussi,Carla Speziale,Miquel Ferrer

doi:10.3390/antibiotics10070798

Abstract

Background: Cardiovascular failure (CVF) may complicate intensive care unit-acquired pneumonia (ICUAP) and radically alters the empirical treatment of this condition. The aim of this study was to determine the impact of CVF on outcome in patients with ICUAP. Methods: A prospective, single-center, observational study was conducted in six medical and surgical ICUs at a University Hospital. CVS was defined as a score of 3 or more on the cardiovascular component of the Sequential Organ Failure Assessment (SOFA) score. At the onset of ICUAP, CVF was reported as absent, transient (if lasting ≤ 3 days) or persistent (>3 days). The primary outcome was 90-day mortality modelled through a Cox regression analysis. Secondary outcomes were 28-day mortality, hospital mortality, ICU length of stay (LOS) and hospital LOS. Results: 358 patients were enrolled: 203 (57%) without CVF, 82 (23%) with transient CVF, and 73 (20%) with persistent CVF. Patients with transient and persistent CVF were more severely ill and presented higher inflammatory response than those without CVF. Despite having similar severity and aetiology, the persistent CVF group more frequently received inadequate initial antibiotic treatment and presented more treatment failures than the transient CVF group. In the persistent CVF group, at day 3, a bacterial superinfection was more frequently detected. The 90-day mortality was significantly higher in the persistent CVF group (62%). The 28-day mortality rates for patients without CVF, with transient and with persistent CVF were 19, 35 and 41% respectively and ICU mortality was 60, 38 and 19% respectively. In the multivariate analysis chronic pulmonary conditions, lack of Pa02/FiO2 improvement at day 3, pulmonary superinfection at day 3 and persistent CVF were independently associated with 90-day mortality in ICUAP patients. Conclusions: Persistent CVF has a significant impact on the outcome of patients with ICUAP. Patients at risk from persistent CVF should be promptly recognized to optimize treatment and outcomes.

Highlights

A total of 361 consecutive patients with intensive care unit-acquired pneumonia (ICUAP) were prospectively enrolled, three of whom were excluded because the Sequential Organ Failure Assessment (SOFA) score was not calculated
The study population consisted of 358 patients: 203 without Cardiovascular failure (CVF) at onset of ventilator-associated pneumonia (VAP), and 155 (43%) with
Patients with CVF had a higher proportion of chronic liver disease, a lower proportion of recent surgery, higher severity scores at intensive care units (ICU) admission and at onset of pneumonia than patients without CVF; in addition, among the reasons for ICU

Summary

Introduction

Despite the success of several pre-emptive and therapeutic strategies in recent years [1,2,3], patients who develop cardiovascular failure (CVF) due to sepsis present high mortality rates, ranging between 20 and 40% depending on the population studied [4,5,6]. Almost a third of patients admitted to intensive care units (ICU) develop CVF during their stay [7,8]. CVF may complicate prognosis by adding secondary organ dysfunctions. It is defined as the need for vasopressor administration with persisting hypotension in order to maintain 4.0/). Cardiovascular failure (CVF) may complicate intensive care unit-acquired pneumonia (ICUAP) and radically alters the empirical treatment of this condition. The 28-day mortality rates for patients without CVF, with transient and with persistent

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