Thiago Lisboa1, Stijn Blot2, Grant W Waterer3, Emili Canalis4, Diego de Mendoza5, Alejandro Rodriguez6, Jordi Rello7. 1. Critical Care Department, Joan XXIII University Hospital & University Rovira i Virgili, Ciber Enfermedades Respiratorias, Tarragona, Spain; Department of Infectious Diseases, Ghent University Hospital, Ghent, Belgium. 2. Faculty of Healthcare, Ghent University College, Ghent, Belgium. 3. School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia. 4. Thoracic Surgery Department, Hospital Clinic, Ciber Enfermedades Respiratorias, Barcelona, Spain. 5. Intensive Care Department, Parc Tauli Hospital, Ciber Enfermedades Respiratorias, Sabadell, Spain. 6. Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium. 7. Critical Care Department, Joan XXIII University Hospital & University Rovira i Virgili, Ciber Enfermedades Respiratorias, Tarragona, Spain. Electronic address: jrello.hj23.ics@gencat.cat.
Abstract
BACKGROUND: It remains unknown whether bacteremia and rapid radiologic progression of pulmonary infiltrates increase the risk of shock and mortality in ICU patients with community-acquired pneumonia (CAP). The objective of this study was to investigate the relative importance of these two factors in the outcome of patients with severe CAP (sCAP). METHODS: A secondary analysis in a multicenter observational study was conducted in 457 patients with CAP admitted to the ICU. Patients were classified into four groups: group RB, rapid radiographic spread of pulmonary infiltrates and bacteremia (n = 48); group R, rapid radiographic spread but no bacteremia (n = 183); group B, bacteremia but without rapid radiographic spread (n = 39); and group C, neither rapid radiographic spread nor bacteremia (n = 187). RESULTS: Logistic regression analysis showed that group RB and group R had a greater risk for shock than group C (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 4.0 to 19.7; and aOR, 3.8; 95% CI, 2.5 to 5.9; respectively), while patients in group B had no increased risk. In addition, compared to group C, group RB and group R had an increased risk of ICU death (aOR, 3.4; 95% CI, 1.4 to 8.1; and aOR, 3.1; 95% CI, 1.7 to 5.7, respectively), while patients in group B had none. CONCLUSIONS: In this cohort of patients with severe CAP, radiologic progression of pulmonary infiltrates in the first 48 h is a significant adverse prognostic feature. In contrast, bacteremia does not affect outcomes.
BACKGROUND: It remains unknown whether bacteremia and rapid radiologic progression of pulmonary infiltrates increase the risk of shock and mortality in ICU patients with community-acquired pneumonia (CAP). The objective of this study was to investigate the relative importance of these two factors in the outcome of patients with severe CAP (sCAP). METHODS: A secondary analysis in a multicenter observational study was conducted in 457 patients with CAP admitted to the ICU. Patients were classified into four groups: group RB, rapid radiographic spread of pulmonary infiltrates and bacteremia (n = 48); group R, rapid radiographic spread but no bacteremia (n = 183); group B, bacteremia but without rapid radiographic spread (n = 39); and group C, neither rapid radiographic spread nor bacteremia (n = 187). RESULTS: Logistic regression analysis showed that group RB and group R had a greater risk for shock than group C (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 4.0 to 19.7; and aOR, 3.8; 95% CI, 2.5 to 5.9; respectively), while patients in group B had no increased risk. In addition, compared to group C, group RB and group R had an increased risk of ICU death (aOR, 3.4; 95% CI, 1.4 to 8.1; and aOR, 3.1; 95% CI, 1.7 to 5.7, respectively), while patients in group B had none. CONCLUSIONS: In this cohort of patients with severe CAP, radiologic progression of pulmonary infiltrates in the first 48 h is a significant adverse prognostic feature. In contrast, bacteremia does not affect outcomes.
Authors: Andres Carrillo; Gumersindo Gonzalez-Diaz; Miquel Ferrer; Maria Elena Martinez-Quintana; Antonia Lopez-Martinez; Noemi Llamas; Maravillas Alcazar; Antoni Torres Journal: Intensive Care Med Date: 2012-02-09 Impact factor: 17.440
Authors: Samuel M Brown; Jason P Jones; Dominik Aronsky; Barbara E Jones; Michael J Lanspa; Nathan C Dean Journal: Respirology Date: 2012-11 Impact factor: 6.424
Authors: J M Bordon; R Fernandez-Botran; T L Wiemken; P Peyrani; S M Uriarte; F W Arnold; L Rodriquez-Hernandez; M J Rane; R R Kelley; L E Binford; S Uppatla; R Cavallazzi; F Blasi; S Aliberti; M I Restrepo; S Fazeli; A Mathur; M Rahmani; K Ayesu; J Ramirez Journal: Infection Date: 2015-09-30 Impact factor: 3.553