Outcomes and prognostic factors for severe community-acquired pneumonia that requires mechanical ventilation.
BACKGROUND
Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation.


METHODS
We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003.


RESULTS
The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16).


CONCLUSIONS
Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.
Lee
Jin Hwa
JH
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. jinhwalee@ewha.ac.kr
Ryu
Yon Ju
YJ
Chun
Eun Mi
EM
Chang
Jung Hyun
JH
D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000150:complications / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome