title: Outcomes in patients with community-acquired pneumonia admitted to the intensive care unit.
abstract: BACKGROUND
  Severe community-acquired pneumonia (CAP) portends a serious prognosis. The temporal trend in outcome of severe CAP is not well established. We evaluated the temporal trends in the outcomes of severe CAP.
  
  
  METHODS
  This is a secondary analysis of 800 patients with severe CAP enrolled in the Community-Acquired Pneumonia Organization International Cohort. Severe CAP was defined as CAP requiring admission to the intensive care unit. Only patients admitted to the ICU upon hospital admission were included in this study. We assessed the trend in outcomes of these patients during three time periods: Period I (June 2001 to April 2004), Period II (May 2004 to January 31 2008), and Period III (February 2008 to February 2013).
  
  
  RESULTS
  After adjustment for other variables, mortality was higher for patients admitted during Period II compared with Period I (RR: 1.46; 95% CI: 1.002 to 2.14; P value = 0.049), and for Period III compared with Period I (RR: 1.70; 95% CI: 1.15 to 2.50; P value = 0.008). No significant difference in length of stay or time to clinical stability was found among the three periods.
  
  
  CONCLUSIONS
  The mortality of patients with severe CAP increased over time in our study population. This finding has important health policy implications if confirmed by other studies.
authors.affiliation: Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY, USA. Electronic address: r0cava01@louisville.edu.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cavallazzi
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. Electronic address: tim.wiemken@louisville.edu.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wiemken
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. Electronic address: f.arnold@louisville.edu.
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Hospital de Clinicas, Universidad de Buenos Aires, Buenos Aires, Argentina. Electronic address: dr.cm.luna@gmail.com.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Providence Hospital, Washington, D.C., USA. Electronic address: jbordon@provhosp.org.
authors.forename: Jose
authors.initials: J
authors.lastname: Bordon
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. Electronic address: robert.kelley@louisville.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Kelley
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: feldmanc@medicine.wits.ac.za.
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.affiliation: Tayside Respiratory Research Group, University of Dundee, Dundee, UK. Electronic address: jamesdchalmers@googlemail.com.
authors.forename: James D
authors.initials: JD
authors.lastname: Chalmers
authors.affiliation: Department of Pneumology, Institute of Thorax (ICT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, University of Barcelona (UB), CIBER de Enfermedades Respiratoria, Spain. Electronic address: atorres@ub.edu.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. Electronic address: julio.ramirez@louisville.edu.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000401:mortality*; D011379:Prognosis; D012044:Regression Analysis
keywords: Cohort; Epidemiology; Infection; Outcomes; Pneumonia; Sepsis