Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management.
OBJECTIVE
To identify risk factors associated with mortality in patients with severe community-acquired pneumonia (CAP) caused by S. pneumoniae who require intensive care unit (ICU) management, and to assess the prognostic values of these risk factors at the time of admission.


METHODS
Retrospective analysis of all consecutive patients with CAP caused by S. pneumoniae who were admitted to the 32-bed medico-surgical ICU of a community and referral university hospital between 2002 and 2011. Univariate and multivariate analyses were performed on variables available at admission.


RESULTS
Among the 77 adult patients with severe CAP caused by S. pneumoniae who required ICU management, 12 patients died (observed mortality rate 15.6%). Univariate analysis indicated that septic shock and low C-reactive protein (CRP) values at admission were associated with an increased risk of death. In a multivariate model, after adjustment for age and gender, septic shock [odds ratio (OR), confidence interval 95%; 4.96, 1.11-22.25; p = 0.036], and CRP (OR 0.99, 0.98-0.99 p = 0.034) remained significantly associated with death. Finally, we assessed the discriminative ability of CRP to predict mortality by computing its receiver operating characteristic curve. The CRP value cut-off for the best sensitivity and specificity was 169.5 mg/L to predict hospital mortality with an area under the curve of 0.72 (0.55-0.89).


CONCLUSIONS
The mortality of patients with S. pneumoniae CAP requiring ICU management was much lower than predicted by severity scores. The presence of septic shock and a CRP value at admission <169.5 mg/L predicted a fatal outcome.
Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
Yok-Ai
YA
Que
Virginie
V
Virgini
Elise Dupuis
ED
Lozeron
Géraldine
G
Paratte
Guy
G
Prod'hom
Jean-Pierre
JP
Revelly
Jean-Luc
JL
Pagani
Emmanuel
E
Charbonney
Philippe
P
Eggimann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein; D017714:Community-Acquired Infections; D015897:Comorbidity; D003422:Critical Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D011018:Pneumonia, Pneumococcal / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013296:Streptococcus pneumoniae
D002097:C-Reactive Protein