title: Hospital-acquired pneumonia in critically ill patients: mortality risk stratification upon onset.
abstract: OBJECTIVE
  To identify, in patients experiencing hospital-acquired pneumonia (HAP), prognostic factors present at disease onset and build an algorithm capable of stratifying mortality risk upon HAP onset.
  
  
  METHODS
  Observational cohort from January 1994 to December 2001.
  
  
  METHODS
  One intensive care unit (ICU) from a university-affiliated, urban teaching hospital.
  
  
  METHODS
  All consecutive patients exhibiting bacteriologically documented HAP either on ICU admission or during ICU stay.
  
  
  METHODS
  Data collection and multivariate analysis using Chi-Square Automatic Interaction and Detection technique.
  
  
  RESULTS
  168 patients were studied. The overall mean mortality rate was 49.4%. Upon onset of HAP, five independent variables allowed binary stratification of mortality risk. These consisted of underlying diseases (nonfatal versus ultimately and rapidly fatal diseases), Simplified Acute Physiology Score II (less than versus > or =37), platelet count (less than versus > or =150,000/mm3), chest x-ray involvement (1 versus >1 lobe), and PaO2/FiO2 (less than versus > or =167 mm Hg). A branching algorithm consisting of these five variables identified patients with HAP at both low (<35%) and high (>75%) risk of mortality.
  
  
  CONCLUSIONS
  Mortality in ICU patients with HAP may be predicted early, upon onset of HAP, by the cumulative use of prognostic factors in an algorithm.
authors.affiliation: Service de Réanimation Médicale et Maladies Infectieuses, Université de Lille, Centre Hospitalier, Tourcoing, France. oleroy@ch-tourcoing.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
authors.forename: Agnès
authors.initials: A
authors.lastname: Meybeck
authors.forename: Thibaud
authors.initials: T
authors.lastname: d'Escrivan
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.forename: Eric
authors.initials: E
authors.lastname: Kipnis
authors.forename: Xavier
authors.initials: X
authors.lastname: Gonin
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
mesh_terms: D000368:Aged; D000465:Algorithms; D016009:Chi-Square Distribution; D016638:Critical Illness; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment