Abstract
BackgroundAcute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission.MethodsThis was a multicenter, observational, prospective study of consecutive CAP patients admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with neither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on admission.ResultsAmong the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C. Patients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p < 0.001), COPD (p < 0.001) and multilobar infiltrates (p < 0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002), residency in nursing home (p = 0.007), COPD (p < 0.001), multilobar involvement (p < 0.001) and renal disease (p < 0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p < 0.001. After adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had an OR of 6.32 (p < 0.001).ConclusionsThe identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.
Highlights
Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP)
Prevalence, characteristics, and risk factors for ARF and SS A total of 2,145 consecutive patients with pneumonia were enrolled during the study period: 47% were males and median (IQR) age was 73 (56–82) years
It was assumed that non-recorded data were in the normal range, and these patients were classified as non-ARF and/or non-SS
Summary
Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission. The natural history of pneumonia could be seen as a continuum from a local disease with neither respiratory nor multi-organ failure to a local disease leading to isolated respiratory failure to a systemic disease involving both respiratory failure and severe sepsis. If this were true, we would expect to see different clinical outcomes according to this three-stage model. In order to test this hypothesis, we decided to evaluate prevalence, characteristics, risk factors, and impact on clinical outcomes of CAP patients with neither ARF nor SS, those with only ARF, and those with both ARF and SS on hospital admission
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