PREDICTING THE NEED FOR INVASIVE VENTILATION WITH APACHE IV SCORE IN PATIENTS WITH SEPSIS FROM COMMUNITY ACQUIRED PNEUMONIA

Abstract

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). Predicting the need for invasive ventilation in patients with sepsis from community-acquired pneumonia and early initiation of mechanical ventilation is a critical strategy in the management of ARF. Acute Physiology and Chronic Health Evaluation (APACHE) IV score has been evaluated in assessing the prognosis of critically ill patients. This study aims to predict the need for invasive ventilation with APACHE IV score in patients with sepsis from community-acquired pneumonia. The secondary outcomes were to predict hospital mortality, vasopressor requirements, and the duration of intensive care unit (ICU) stay. METHODS: A retrospective chart review was performed on adult ICU patients admitted with sepsis due to CAP from July 2017 until July 2020 at Metropolitan Hospital Centre. APACHE IV scores were calculated on patients on day one of admission. Based on day one APACHE IV score, patients were grouped into mild, moderate, and severe categories. Patients with APACHE IV score of 25-50 were grouped into the mild category, patients with APACHE IV score of 51-75 were grouped into the moderate category, and patients with APACHE IV score of more than 75 were grouped into the severe category. Each patient was evaluated for the outcomes of invasive ventilation, hospital mortality, vasopressor requirement, and duration of ICU stay. The outcomes were then compared between the three categories. RESULTS: In total, there were 93 patients selected. The mild category had 28 patients, the moderate category had 45 patients, and the severe category had 20 patients. The severe category had the highest need for invasive ventilation (85%), the highest hospital mortality (50%), and the highest vasopressor requirement (5.5 days). Statistical analysis was performed using ordinal regression and multinomial logistics. There was a trend towards statistical significance in the outcome of invasive ventilation requirement with a P-value of 0.06. The differences between the three categories were statistically significant in the vasopressor requirement with a P-value of 0.047. However, the outcomes of hospital mortality and duration of MICU stay were not statistically significant, with P values of 0.16 and 0.10, respectively. CONCLUSIONS: In patients with sepsis from community-acquired pneumonia, high APACHE IV scores can indicate a higher need for invasive ventilation and a higher need for vasopressor requirements. CLINICAL IMPLICATIONS: The APACHE IV scoring system can be helpful in triaging patients with sepsis from CAP and in identifying patients at higher risk of acute respiratory failure and the need for invasive ventilation. DISCLOSURES: No relevant relationships by Antony Arumairaj, source=Web Response No relevant relationships by Imnett Habtes, source=Web Response No relevant relationships by Thomas Newman, source=Web Response No relevant relationships by Hansang Park, source=Web Response No relevant relationships by Julio Valencia, source=Web Response