Korean J Intern Med.  2007 Sep;22(3):157-163. 10.3904/kjim.2007.22.3.157.

Outcomes and Prognostic Factors for Severe Community-Acquired Pneumonia that Requires Mechanical Ventilation

• Lee JH
• Ryu YJ
• Chun EM
• Chang JH

• KMID: 1785621
• DOI: http://doi.org/10.3904/kjim.2007.22.3.157

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) remains a common and serious condition worldwide. The mortality from severe CAP remains high, and this has reached 50% in some series. This study was conducted to determine the mortality and predictors that contribute to in-hospital mortality for patients who exhibit CAP and acute respiratory failure that requires mechanical ventilation. METHODS: We retrospectively reviewed the medical records of 85 patients with severe CAP as a primary cause of acute respiratory failure, and this required mechanical ventilation in a setting of the medical intensive care unit (ICU) of a tertiary university hospital between 2000 and 2003. RESULTS: The overall in-hospital mortality was 56% (48/85). A Cox-proportional hazard model revealed that the independent predictive factors of in-hospital mortality included a PaCO2 of less than 45 mmHg (p<0.001, relative risk [RR]: 4.73; 95% confidence interval [CI]: 2.16-10.33), a first 24-hour urine output of less than 1.5 L (p=0.006, RR: 2.46, 95% CI: 1.29-4.66) and a high APACHE II score (p=0.004, RR: 1.09, 95% CI: 1.03-1.16). CONCLUSIONS: Acute respiratory failure caused by severe CAP and that necessitates mechanical ventilation is associated with a high mortality rate. Initial hypercapnia and a large urine output favored survival, whereas a high APACHE II score predicted mortality.

Keyword

APACHE; Hypercapnia; Mechanical ventilation; Mortality; Pneumonia

MeSH Terms

Aged
Aged, 80 and over
Community-Acquired Infections/complications/mortality/therapy
Female
Hospital Mortality
Humans
Hypercapnia
Male
Middle Aged
Pneumonia, Bacterial/complications/*diagnosis/*mortality/therapy
Predictive Value of Tests
Prognosis
Respiration, Artificial
Respiratory Insufficiency/*diagnosis/etiology/*mortality/therapy
Retrospective Studies
Treatment Outcome