Hospital-acquired pneumonia in critically ill patients: mortality risk stratification upon onset.
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.
Leroy
Olivier
O
Service de Réanimation Médicale et Maladies Infectieuses, Université de Lille, Centre Hospitalier, Tourcoing, France. oleroy@ch-tourcoing.fr
Meybeck
Agnès
A
d'Escrivan
Thibaud
T
Devos
Patrick
P
Kipnis
Eric
E
Gonin
Xavier
X
Georges
Hugues
H
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