title: Predictors of Severe Sepsis among Patients Hospitalized for Community-Acquired Pneumonia.
abstract: BACKGROUND
  Severe sepsis, may be present on hospital arrival in approximately one-third of patients with community-acquired pneumonia (CAP).
  
  
  OBJECTIVE
  To determine the host characteristics and micro-organisms associated with severe sepsis in patients hospitalized with CAP.
  
  
  RESULTS
  We performed a prospective multicenter cohort study in 13 Spanish hospital, on 4070 hospitalized CAP patients, 1529 of whom (37.6%) presented with severe sepsis. Severe sepsis CAP was independently associated with older age (>65 years), alcohol abuse (OR, 1.31; 95% CI, 1.07-1.61), chronic obstructive pulmonary disease (COPD) (OR, 1.75; 95% CI, 1.50-2.04) and renal disease (OR, 1.57; 95% CI, 1.21-2.03), whereas prior antibiotic treatment was a protective factor (OR, 0.62; 95% CI, 0.52-0.73). Bacteremia (OR, 1.37; 95% CI, 1.05-1.79), S pneumoniae (OR, 1.59; 95% CI, 1.31-1.95) and mixed microbial etiology (OR, 1.65; 95% CI, 1.10-2.49) were associated with severe sepsis CAP.
  
  
  CONCLUSIONS
  CAP patients with COPD, renal disease and alcohol abuse, as well as those with CAP due to S pneumonia or mixed micro-organisms are more likely to present to the hospital with severe sepsis.
authors.affiliation: Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.affiliation: Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
authors.affiliation: Pneumology Department, Hospital Clínico y Provincial, IDIBAPS, CIBER Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Reyes
authors.affiliation: Pneumology Department, ISS/Hospital Universitario y Politecnico La Fe, CIBER Enfermedades Respiratorias (CIBERES), Valencia, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Méndez
authors.affiliation: Pneumology Department, Hospital Cruces, Vizcaya, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Zalacaín
authors.affiliation: Pneumology Department, Hospital Galdakao, Vizcaya, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.affiliation: Pneumology Department, Hospital La Princesa, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Rajas
authors.affiliation: Pneumology Department, Hospital San Jorge, Huesca, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Borderías
authors.affiliation: Pneumology Department, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Martin-Villasclaras
authors.affiliation: Pneumology Department, Hospital Miguel Servet, Zaragoza, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Bello
authors.affiliation: Pneumology Department, Hospital Valme, Sevilla, Spain.
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alfageme
authors.affiliation: Pneumology Department, Hospital Doctor Negrin Las Palmas, Gran Canaria, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Rodríguez de Castro
authors.affiliation: Critical Care Department, Hospital Joan XXII of Tarragona and Hospital Vall Hebron, Universtitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Pneumology Department, Hospital Central Asturias, Oviedo, Asturias, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Molinos
authors.affiliation: Pneumology Department, Hospital Germans Trias i Pujol Badalona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ruiz-Manzano
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000150:complications* / Q000382:microbiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000150:complications* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000150:complications* / Q000821:virology; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012720:Severity of Illness Index