Phenotyping community-acquired pneumonia according to the presence of acute respiratory failure and severe sepsis

Stefano Aliberti, Anna M. Brambilla, James D. Chalmers, Catia Cilloniz, Julio Ramirez, Angelo Bignamini, Elena Prina, Eva Polverino, Paolo Tarsia, Alberto Pesci, Antoni Torres, Francesco Blasi, Roberto Cosentini

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number27
JournalRespiratory Research
Volume15
Issue number1
DOIs
Publication statusPublished - Apr 3 2014

Keywords

  • Acute respiratory failure
  • ARDS
  • CAP
  • Community-acquired pneumonia
  • Mortality
  • Oxygenation
  • Pneumonia
  • Sepsis
  • Severe sepsis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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