Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

Authors: Hoogewerf, M.¹; Oosterheert, J. J.¹; Hak, E.²; Hoepelman, I. M.; Bonten, M. J. M.

Source: Clinical Microbiology & Infection, Volume 12, Number 11, November 2006 , pp. 1097-1104(8)

Publisher: Wiley-Blackwell

Abstract:

For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO₂ <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38°C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO₂ <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.

Keywords: Clinical failure; community-acquired pneumonia; management; outcome; prognosis; risk-factors

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1469-0691.2006.01535.x

Affiliations: 1: Department of Internal Medicine and Infectious Diseases 2: Julius Center for Health Sciences and Primary Care

Publication date: 2006-11-01

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