TY - JOUR
T1 - Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis
AU - Aliberti, Stefano
AU - Brambilla, Anna M.
AU - Chalmers, James D.
AU - Cilloniz, Catia
AU - Ramirez, Julio
AU - Bignamini, Angelo
AU - Prina, Elena
AU - Polverino, Eva
AU - Tarsia, Paolo
AU - Pesci, Alberto
AU - Torres, Antoni
AU - Blasi, Francesco
AU - Cosentini, Roberto
PY - 2014/4/3
Y1 - 2014/4/3
N2 - Background: Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission.Methods: This was a multicenter, observational, prospective study of consecutive CAP patients admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with neither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on admission.Results: Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C. Patients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p <0.001), COPD (p <0.001) and multilobar infiltrates (p <0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002), residency in nursing home (p = 0.007), COPD (p <0.001), multilobar involvement (p <0.001) and renal disease (p <0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p <0.001. After adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had an OR of 6.32 (p <0.001).Conclusions: The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.
AB - Background: Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with community-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors and impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission.Methods: This was a multicenter, observational, prospective study of consecutive CAP patients admitted to three hospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with neither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on admission.Results: Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C. Patients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p <0.001), COPD (p <0.001) and multilobar infiltrates (p <0.001). The contemporary occurrence of ARF and SS was associated with age (p = 0.002), residency in nursing home (p = 0.007), COPD (p <0.001), multilobar involvement (p <0.001) and renal disease (p <0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p <0.001. After adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence of both ARF and SS had an OR of 6.32 (p <0.001).Conclusions: The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients into three different clinical phenotypes.
KW - Acute respiratory failure
KW - ARDS
KW - CAP
KW - Community-acquired pneumonia
KW - Mortality
KW - Oxygenation
KW - Pneumonia
KW - Sepsis
KW - Severe sepsis
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U2 - 10.1186/1465-9921-15-27
DO - 10.1186/1465-9921-15-27
M3 - Article
C2 - 24593040
AN - SCOPUS:84899481153
VL - 15
JO - Respiratory Research
JF - Respiratory Research
SN - 1465-9921
IS - 1
M1 - 27
ER -