title: Pneumonia presenting with organ dysfunctions: Causative microorganisms, host factors and outcome.
abstract: Community-acquired pneumonia (CAP) is a serious infection that may occasionally rapidly evolve provoking organ dysfunctions. We aimed to characterize CAP presenting with organ dysfunctions at the emergency room, with regard to host factors and causative microorganisms, and its impact on 30-day mortality. 460 of 4070 (11.3%) CAP patients had ≥2 dysfunctions at diagnosis, with a 30-day mortality of 12.4% vs. 3.4% in those with one or no dysfunctions. Among them, the most frequent causative microorganisms were Streptococcus pneumoniae, gram-negatives and polymicrobial etiology. Independent host risk factors for presenting with ≥2 dysfunctions were: liver (OR 2.97) and renal diseases (OR 3.91), neurological disorders (OR 1.86), and COPD (OR 1.30). Methicillin-resistant Staphylococcus aureus (OR 6.41) and bacteraemic episodes (OR 1.68) had the higher independent risk among microorganisms. The number of organ dysfunctions vs. none increased at 30-day mortality: three organs (OR 11.73), two organs (OR 4.29), and one organ (OR 2.42) whereas Enterobacteria (OR 3.73) were also independently related to mortality. The number of organ dysfunctions was the strongest 30-day mortality risk factor while Enterobacteriaceae was also associated with poorer outcome. The assessment of organ dysfunctions in CAP should be implemented for management, allocation and treatment decisions on initial evaluation.
authors: Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Valencia, CIBERES, Spain. Electronic address: rosmenend@gmail.com.
authors: Rosario
authors: R
authors: Menéndez
authors: Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Valencia, CIBERES, Spain; Dept. of Medicine-Doctoral Programme, Barcelona Autonomous University, Barcelona, Spain.
authors: Beatriz
authors: B
authors: Montull
authors: Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Valencia, CIBERES, Spain.
authors: Soledad
authors: S
authors: Reyes
authors: Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Valencia, CIBERES, Spain.
authors: Isabel
authors: I
authors: Amara-Elori
authors: Servicio de Neumología, Hospital de Cruces, Bilbao, Spain. Electronic address: rafael.zalacainjorge@osakidetza.net.
authors: Rafael
authors: R
authors: Zalacain
authors: Servicio de Neumología, Hospital de Galdakao, Spain. Electronic address: alberto.capelasteguisaiz@osakidetza.net.
authors: Alberto
authors: A
authors: Capelastegui
authors: Servicio de Neumología, Hospital de la Princesa, Madrid, Spain. Electronic address: jaspa@separ.es.
authors: Javier
authors: J
authors: Aspa
authors: Servicio de Neumología, Hospital San Jorge, Huesca, Spain. Electronic address: lborderias@salud.aragon.es.
authors: Luis
authors: L
authors: Borderías
authors: Servicio de Neumología, Hospital Carlos Haya, Malaga, Spain. Electronic address: jjvillas@gmail.com.
authors: Juan J
authors: JJ
authors: Martín-Villasclaras
authors: Servicio de Neumología, Hospital Miguel Servet, Zaragoza, Spain. Electronic address: sbello@salud.aragon.es.
authors: Salvador
authors: S
authors: Bello
authors: Servicio de Neumología, Hospital de Valme, Sevilla, Spain. Electronic address: Ialfageme@separ.es.
authors: Inmaculada
authors: I
authors: Alfageme
authors: Universidad de Las Palmas de Gran Canaria, Spain. Electronic address: frodcasw@gobiernodecanarias.org.
authors: Felipe
authors: F
authors: Rodríguez de Castro
authors: Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Spain. Electronic address: jrello@crips.es.
authors: Jordi
authors: J
authors: Rello
authors: Servicio de Neumología, Hospital Central Asturias, Oviedo, Spain. Electronic address: luismol@telefonica.net.
authors: Luis
authors: L
authors: Molinos
authors: Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Spain. Electronic address: jruiz@separ.es.
authors: Juan
authors: J
authors: Ruiz-Manzano
authors: Servei de Pneumologia, Institut Clinic del Torax, IDIBAPS, Universitat de Barcelona, CIBERES, GRS, Spain. Electronic address: atorres@clinic.ub.es.
authors: Antoni
authors: A
authors: Torres
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections; D015897:Comorbidity; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections; D006801:Humans; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000382:microbiology* / Q000401:mortality*; D011014:Pneumonia / Q000150:complications*; D011023:Pneumonia, Staphylococcal; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Community-acquired pneumonia; Comorbidity; Mortality; Organ dysfunction; Risk factors