BACKGROUND: Pneumonia is the primary source of sepsis and is significantly associated with mortality. However, only a few studies focus on its clinical characteristics and outcomes. METHODS: We evaluated 500 intensive care unit patients who met severe sepsis or septic shock criteria, dividing them into two distinct groups (43%, sepsis with pneumonia; 41%, sepsis with an infection other than pneumonia). RESULTS: Moderate differences between the groups were observed. The group of sepsis with pneumonia had a higher 28-day in-hospital mortality (41% vs. 30%; P=0.02). Multivariate analysis revealed that the presence of pneumonia associated significantly with mortality (OR 1.76, 95% CI 1.11-2.78) along with cardiopulmonary resuscitation (OR 4.20, 95% CI 1.50-11.74), serum lactate ≥ 3.5 mmol/L (OR 1.92, 95% CI 1.20-3.08), and SOFA score ≥ 12 (OR 2.41, 95% CI 1.52-3.82). Survival analysis revealed for both groups that the patients with PaO2/FiO2 (PF) ratio <170 and lactate ≥ 3.5 mmol/L had a worse prognosis than the patients with PF ratio ≥ 170 and lactate ≥ 3.5 mmol/L or PF ratio <170 and lactate <3.5 mmol/L. CONCLUSION: In patients admitted with sepsis, the pneumonia infection independently predicts 28-day in-hospital mortality. Combining the levels of serum lactate and PF ratio could be a useful approach in predicting mortality of these patients.
BACKGROUND:Pneumonia is the primary source of sepsis and is significantly associated with mortality. However, only a few studies focus on its clinical characteristics and outcomes. METHODS: We evaluated 500 intensive care unit patients who met severe sepsis or septic shock criteria, dividing them into two distinct groups (43%, sepsis with pneumonia; 41%, sepsis with an infection other than pneumonia). RESULTS: Moderate differences between the groups were observed. The group of sepsis with pneumonia had a higher 28-day in-hospital mortality (41% vs. 30%; P=0.02). Multivariate analysis revealed that the presence of pneumonia associated significantly with mortality (OR 1.76, 95% CI 1.11-2.78) along with cardiopulmonary resuscitation (OR 4.20, 95% CI 1.50-11.74), serum lactate ≥ 3.5 mmol/L (OR 1.92, 95% CI 1.20-3.08), and SOFA score ≥ 12 (OR 2.41, 95% CI 1.52-3.82). Survival analysis revealed for both groups that the patients with PaO2/FiO2 (PF) ratio <170 and lactate ≥ 3.5 mmol/L had a worse prognosis than the patients with PF ratio ≥ 170 and lactate ≥ 3.5 mmol/L or PF ratio <170 and lactate <3.5 mmol/L. CONCLUSION: In patients admitted with sepsis, the pneumonia infection independently predicts 28-day in-hospital mortality. Combining the levels of serum lactate and PF ratio could be a useful approach in predicting mortality of these patients.
Authors: Manuela Nickler; Manuel Ottiger; Christian Steuer; Andreas Huber; Janet Byron Anderson; Beat Müller; Philipp Schuetz Journal: Respir Res Date: 2015-10-15