title: Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation.
abstract: OBJECTIVE
  To evaluate the variables associated with mortality of patients with community-acquired pneumonia who require mechanical ventilation and to determine the attributable morbidity and intensive care unit (ICU) mortality of community-acquired pneumonia.
  
  
  METHODS
  Retrospective cohort study carried out in 361 ICUs from 20 countries including 124 patients who required mechanical ventilation on the first day of admission to the hospital due to acute respiratory failure secondary to severe community-acquired pneumonia. To assess the factors associated with outcome, a forward stepwise logistic regression analysis was performed, and to determine the attributable mortality of community-acquired pneumonia, a matched study design was used.
  
  
  RESULTS
  We found 3 independent variables significantly associated with death in patients with community-acquired pneumonia requiring mechanical ventilation: simplified acute physiological score greater than 45 (odds ratio, 5.5 [95% confidence interval, 1.7-12.3]), shock (odds ratio, 5.7 [95% confidence interval, 1.7-10.1]), and acute renal failure (odds ratio, 3.0 [95% confidence interval, 1.1-4.0]). There was no statistically significant difference in ICU mortality among patients with or without community-acquired pneumonia (32% vs 35%; P=.59).
  
  
  CONCLUSIONS
  Community-acquired pneumonia needing mechanical ventilation is not a disease associated with higher mortality. The main determinants of patient outcome were initial severity of illness and the development of shock and/or acute renal failure.
authors.affiliation: Intensive Care Unit, Hospital Universitario de Getafe, 28905-Getafe, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Tejerina
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.forename: Fernando
authors.initials: F
authors.lastname: Palizas
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.forename: Carlos
authors.initials: C
authors.lastname: Apezteguía
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Dimitros
authors.initials: D
authors.lastname: Matamis
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bugedo
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
mesh_terms: D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index