Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis

Respiratory Research

Roberto Cosentini⁷  Francesco Blasi²  Antoni Torres⁵  Alberto Pesci⁴  Paolo Tarsia²  Eva Polverino⁵  Elena Prina⁷  Angelo Bignamini¹  Julio Ramirez³  Catia Cilloniz⁵  James D Chalmers⁶  Anna Maria Brambilla⁷  Stefano Aliberti⁴ 

[1] School of Specialization in Hospital Pharmacy, University of Milan, Via Colombo, 71, Milan, Italy;Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Via F. Sforza 35, Milan, Italy;Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY, USA;Clinica Pneumologica, Department of Health Science, University of Milan Bicocca, AO San Gerardo, Via Pergolesi 33, Monza, Italy;Hospital Clínic, IDIBAPS, Ciberes, Barcelona, Spain;Tayside Respiratory Research Group, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK;Emergency Medicine Department, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy

关键词: Oxygenation;    Mortality;    Community-acquired pneumonia;    CAP;    ARDS;    Acute respiratory failure;    Severe sepsis;    Sepsis;    Pneumonia;   

Others  :  790385
DOI  :  10.1186/1465-9921-15-27

 received in 2013-12-17, accepted in 2014-02-20,  发布年份 2014

【 摘 要 】

Background

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.

Methods

This 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.

Results

Among 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).

Conclusions

The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.

【 授权许可】

   
2014 Aliberti et al.; licensee BioMed Central Ltd.

【 图 表 】

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