Predictive factors for septic shock in patients with ventilator-associated pneumonia.
BACKGROUND
Ventilator-associated pneumonia (VAP) is one of the most frequent infections in intensive care units (ICUs), and nearly 50% of patients with VAP develop septic shock. Septic shock is an independent predictor for mortality in these patients.


OBJECTIVE
To investigate the predictors for septic shock in VAP patients receiving appropriate antibiotic therapy.


METHODS
Eighty-nine patients with microbiologically confirmed VAP who were receiving appropriate antibiotic therapy were included in the study. They were divided into two groups according to the existence of septic shock. Clinical, hematological, biochemical and microbiological characteristics were compared.


RESULTS
Thirty-seven percent of the patients developed septic shock. Advanced age (OR 1.07, 95% CI 1.02-1.13, P = 0.009), lymphocytopenia (<1000/mm3) (OR 7.48, 95% CI 1.91-29, P = 0.004), high blood glucose levels >120 mg/dL (OR 4.75, 95% CI 1.38-16, P = 0.014), and increased clinical pulmonary infection scores (CPIS) (OR 1.64, 95% CI 1.16-2.33, P = 0.006) were identified as independent predictors for the development of septic shock.


CONCLUSIONS
Some clinical parameters such as lymphocytopenia, blood glucose >120 mg/dL, increasing age, and CPIS can predict septic shock during VAP, but large randomized controlled studies are needed to confirm these results.
Aydogdu
Muge
M
Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Besevler, Ankara, Turkey. maydogdu@gazi.edu.tr
Gursel
Gul
G
D018806:APACHE; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000150:complications* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy
D001786:Blood Glucose