In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

Vicco, Miguel Hernán; Ferini, Franco; Rodeles, Luz; Scholtus, Patricia; Long, Ana Karina; Musacchio, Héctor Mario

doi:10.1590/1806-9282.61.02.144

Cited by 6 publications

(4 citation statements)

References 30 publications

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“…Ding et al [ 11 ] reported 20.6% 30-day in-hospital mortality in 890 CAP patients aged 65 years or older; anemia was not looked at in their study. Vicco et al [ 12 ] looked at in-hospital mortality risk factors in patients with CAP and found that white blood cell count was associated with significantly higher rates of mortality; we found a similar association. Several studies have examined the prevalence of anemia in pneumonia and its association with mortality in patients hospitalized with CAP.…”

Section: Discussionsupporting

confidence: 79%

Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

et al. 2018

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Patients hospitalized with pneumonia may require packed red blood cell (RBC) transfusion during their hospital stay. Patient survival may be associated with the transfusion trigger. These patients may need a higher hemoglobin (Hb) trigger than that suggested by the AABB guidelines (7 g/dL).The objective of this study was to evaluate the association between the initial transfusion Hb trigger and in-hospital mortality.A historical cohort study of all patients hospitalized in an internal medicine ward between 2009 and 2014 with pneumonia, who received at least 1 unit of RBC, was evaluated. The primary outcome was all-cause in-hospital mortality.One hundred males and 77 females with a median age of 80 (interquartile range 71–87) years were included. The median Hb trigger was 8.10 g/dL. Mortality rate was 56% in patients with Hb trigger ≤7 g/dL, 43.8% in Hb trigger 7 to 8 g/dL, and 29.5% in Hb trigger >8 g/dL (P = .045). Patients in the 3 Hb trigger categories did not differ in age, sex, comorbidities, albumin, creatinine, C-reactive protein, white blood cells, and platelet counts. The result of a multivariate analysis showed that only lower Hb trigger (odds ratio [OR]≤ 7vs.>8 = 5.24, OR7–8vs.>8 = 2.13, P = .035) and higher neutrophil count (P = .012) were associated with increased in-hospital mortality.In conclusion, a lower transfusion trigger is associated with increased risk for in-hospital mortality in patients hospitalized with pneumonia requiring RBC transfusion.

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Section: Discussionsupporting

confidence: 79%

Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

et al. 2018

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“…Similar to the results of our study, the PaCO 2 value was not significantly different between the group of patients who died of CAP and those who survived (19).…”

Section: Discussionsupporting

confidence: 91%

Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

Yassin¹,

Saadat²,

Abtahi³

et al. 2016

J. Thorac. Dis.

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Background: There is little data about the correlation between the outcome of community acquired pneumonia (CAP) and the hypercapnic type respiratory failure. In this study we prospectively investigated the prognostic significance of first arterial CO 2 tension in patients hospitalized with CAP.Methods: In this prospective study patients with CAP, admitted to a general hospital were included. PaCO 2 was measured for each subject in an arterial blood sample drawn in the first 2 hours and its correlations with three major outcomes were evaluated: intensive care unit (ICU) admission, duration of admission and mortality in 30 days.Results: A total of 114 patients (mean age: 60.9±18.3; male: 51.8%) diagnosed with CAP were included.Significant relationship was not found between PaCO 2 and mortality (P=0.544) or ICU admission (P=0.863).However advanced age, associated CHF, high BUN levels, high CURB-65 scores, associated pleural effusion in chest X-ray and being admitted to the ICU (P=0.012, 0.004, 0.003, <0.001, 0.045 and <0.001 respectively)were all significant prognostic factors of higher mortality risks. Prognostic factors for ICU admission were a history of malignancy (P=0.004), higher CURB-65 (P<0.001) scores and concomitant pleural effusion (P=0.028) in chest X-ray. Hypercapnic patients hospitalized for longer duration compared with normocapnic subjects. Furthermore, patients with lower pH (P=0.041) and pleural effusions (P=0.002) were hospitalized longer than the others.Conclusions: There was less prominent prognostic value regarding on-admission PaCO 2 in comparison to other factors such as CURB-65. Considering the inconsistent results of surveys conducted on prognostic value of PaCO 2 for CAP outcomes, further investigations are required to reach a consensus on this matter.

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“…Prior work that specifically evaluated pneumonia and ICU severity scores, such as the Pneumonia Severity Index, CURB-65, SAPS and acute physiology and chronic health evaluation (APACHE), have demonstrated poor performance in predicting pneumonia mortality in the ICU. [21][22][23] While other studies have evaluated pneumonia and ICU severity scores, most failed to include patients in the ICU and others focused exclusively on patients with community acquired pneumonia. [24][25][26] Furthermore, these studies have either excluded those patients directly PA GE 6 admitted to the ICU or focused narrowly on ventilator associated pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of a Novel Severity Scoring System for Pneumonia at Intensive Care Unit Admission

Carmo

Ferreira

Menezes

et al. 2020

Clinical Infectious Diseases

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Abstract Background Severity stratification scores developed in intensive care units (ICUs) are used in interventional studies to identify the most critically ill. Studies that evaluate accuracy of these scores in ICU patients admitted with pneumonia are lacking. This study aims to determine performance of severity scores as predictors of mortality in critically ill patients admitted with pneumonia. Methods Prospective cohort study in a general ICU in Brazil. ICU severity scores (Simplified Acute Physiology Score 3 [SAPS 3] and Sepsis-Related Organ Failure Assessment [qSOFA]), prognostic scores of pneumonia (CURB-65 [confusion, urea, respiratory rate, blood pressure, age] and CRB-65 [confusion, respiratory rate, blood pressure, age]), and clinical and epidemiological variables in the first 6 hours of hospitalization were analyzed. Results Two hundred patients were included between 2015 and 2018, with a median age of 81 years (interquartile range, 67–90 years) and female predominance (52%), primarily admitted from the emergency department (65%) with community-acquired pneumonia (CAP, 80.5%). SAPS 3, CURB-65, CRB-65,and qSOFA all exhibited poor performance in predicting mortality. Multivariate regression identified variables independently associated with mortality that were used to develop a novel pneumonia-specific ICU severity score (Pneumonia Shock score) that outperformed SAPS 3, CURB-65, and CRB-65. The Shock score was validated in an external multicenter cohort of critically ill patients admitted with CAP. Conclusions We created a parsimonious score that accurately identifies patients with pneumonia at highest risk of ICU death. These findings are critical to accurately stratify patients with severe pneumonia in therapeutic trials that aim to reduce mortality.

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In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

Abstract: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP.

Cited by 6 publications

References 30 publications

Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

Lower hemoglobin transfusion trigger is associated with higher mortality in patients hospitalized with pneumonia

Prognostic value of on admission arterial PCO2 in hospitalized patients with community-acquired pneumonia

Derivation and Validation of a Novel Severity Scoring System for Pneumonia at Intensive Care Unit Admission

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