title: Radiologic progression of pulmonary infiltrates predicts a worse prognosis in severe community-acquired pneumonia than bacteremia.
abstract: BACKGROUND
  It remains unknown whether bacteremia and rapid radiologic progression of pulmonary infiltrates increase the risk of shock and mortality in ICU patients with community-acquired pneumonia (CAP). The objective of this study was to investigate the relative importance of these two factors in the outcome of patients with severe CAP (sCAP).
  
  
  METHODS
  A secondary analysis in a multicenter observational study was conducted in 457 patients with CAP admitted to the ICU. Patients were classified into four groups: group RB, rapid radiographic spread of pulmonary infiltrates and bacteremia (n = 48); group R, rapid radiographic spread but no bacteremia (n = 183); group B, bacteremia but without rapid radiographic spread (n = 39); and group C, neither rapid radiographic spread nor bacteremia (n = 187).
  
  
  RESULTS
  Logistic regression analysis showed that group RB and group R had a greater risk for shock than group C (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 4.0 to 19.7; and aOR, 3.8; 95% CI, 2.5 to 5.9; respectively), while patients in group B had no increased risk. In addition, compared to group C, group RB and group R had an increased risk of ICU death (aOR, 3.4; 95% CI, 1.4 to 8.1; and aOR, 3.1; 95% CI, 1.7 to 5.7, respectively), while patients in group B had none.
  
  
  CONCLUSIONS
  In this cohort of patients with severe CAP, radiologic progression of pulmonary infiltrates in the first 48 h is a significant adverse prognostic feature. In contrast, bacteremia does not affect outcomes.
authors.affiliation: Critical Care Department, Joan XXIII University Hospital & University Rovira i Virgili, Ciber Enfermedades Respiratorias, Tarragona, Spain; Department of Infectious Diseases, Ghent University Hospital, Ghent, Belgium.
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.affiliation: Faculty of Healthcare, Ghent University College, Ghent, Belgium.
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Waterer
authors.affiliation: Thoracic Surgery Department, Hospital Clinic, Ciber Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Emili
authors.initials: E
authors.lastname: Canalis
authors.affiliation: Intensive Care Department, Parc Tauli Hospital, Ciber Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: de Mendoza
authors.affiliation: Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Critical Care Department, Joan XXIII University Hospital & University Rovira i Virgili, Ciber Enfermedades Respiratorias, Tarragona, Spain. Electronic address: jrello.hj23.ics@gencat.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D003422:Critical Care; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors