Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients

Miquel Ferrer, Chiara Travierso, Catia Cilloniz, Albert Gabarrus, Otavio T. Ranzani, Eva Polverino, Adamantia Liapikou, Francesco Blasi, Antoni Torres

Research output: Contribution to journalArticle

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Abstract

Background Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. Methods We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Results Among 3,719 patients hospitalized with CAP, 664 (18%) had criteria for SCAP, and 154 (23%) received IMV at presentation of pneumonia; 198 (30%) presented with septic shock. In 370 (56%) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33%, vs. 94, 18% respectively, p<0.001), and higher than that predicted by APACHE-II score (26%). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3.54, 95% confidence interval 1.45±8.37, p = 0.006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Conclusion Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.

Original languageEnglish
Article numbere0191721
JournalPLoS One
Volume13
Issue number1
DOIs
Publication statusPublished - Jan 1 2018

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pneumonia
Pneumonia
Artificial Respiration
Mortality
septic shock
Septic Shock
Pathogens
Propensity Score
Streptococcus pneumoniae
APACHE
Health Services Needs and Demand
Logistics
Potassium
Respiratory Insufficiency
odds ratio
multivariate analysis
morbidity
hypoxia
confidence interval
clinical trials

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Ferrer, M., Travierso, C., Cilloniz, C., Gabarrus, A., Ranzani, O. T., Polverino, E., ... Torres, A. (2018). Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients. PLoS One, 13(1), [e0191721]. https://doi.org/10.1371/journal.pone.0191721

Severe community-acquired pneumonia : Characteristics and prognostic factors in ventilated and non-ventilated patients. / Ferrer, Miquel; Travierso, Chiara; Cilloniz, Catia; Gabarrus, Albert; Ranzani, Otavio T.; Polverino, Eva; Liapikou, Adamantia; Blasi, Francesco; Torres, Antoni.

In: PLoS One, Vol. 13, No. 1, e0191721, 01.01.2018.

Research output: Contribution to journalArticle

Ferrer, M, Travierso, C, Cilloniz, C, Gabarrus, A, Ranzani, OT, Polverino, E, Liapikou, A, Blasi, F & Torres, A 2018, 'Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients', PLoS One, vol. 13, no. 1, e0191721. https://doi.org/10.1371/journal.pone.0191721
Ferrer, Miquel ; Travierso, Chiara ; Cilloniz, Catia ; Gabarrus, Albert ; Ranzani, Otavio T. ; Polverino, Eva ; Liapikou, Adamantia ; Blasi, Francesco ; Torres, Antoni. / Severe community-acquired pneumonia : Characteristics and prognostic factors in ventilated and non-ventilated patients. In: PLoS One. 2018 ; Vol. 13, No. 1.
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abstract = "Background Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. Methods We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Results Among 3,719 patients hospitalized with CAP, 664 (18{\%}) had criteria for SCAP, and 154 (23{\%}) received IMV at presentation of pneumonia; 198 (30{\%}) presented with septic shock. In 370 (56{\%}) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33{\%}, vs. 94, 18{\%} respectively, p<0.001), and higher than that predicted by APACHE-II score (26{\%}). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3.54, 95{\%} confidence interval 1.45±8.37, p = 0.006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Conclusion Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.",
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AU - Gabarrus, Albert

AU - Ranzani, Otavio T.

AU - Polverino, Eva

AU - Liapikou, Adamantia

AU - Blasi, Francesco

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N2 - Background Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. Methods We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Results Among 3,719 patients hospitalized with CAP, 664 (18%) had criteria for SCAP, and 154 (23%) received IMV at presentation of pneumonia; 198 (30%) presented with septic shock. In 370 (56%) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33%, vs. 94, 18% respectively, p<0.001), and higher than that predicted by APACHE-II score (26%). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3.54, 95% confidence interval 1.45±8.37, p = 0.006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Conclusion Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.

AB - Background Patients with severe community-acquired pneumonia (SCAP) and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV). Since use of IMV is often associated with significant morbidity and mortality, we assessed whether patients invasively ventilated would represent a target population for interventions aimed at reducing mortality of SCAP. Methods We prospectively recruited consecutive patients with SCAP for 12 years. We assessed the characteristics and outcomes of patients invasively ventilated at presentation of pneumonia, compared with those without IMV, and determined the influence of risks factors on mortality with a multivariate weighted logistic regression using a propensity score. Results Among 3,719 patients hospitalized with CAP, 664 (18%) had criteria for SCAP, and 154 (23%) received IMV at presentation of pneumonia; 198 (30%) presented with septic shock. In 370 (56%) cases SCAP was diagnosed based solely on the presence of 3 or more IDSA/ ATS minor criteria. Streptococcus pneumoniae was the main pathogen in both groups. The 30-day mortality was higher in the IMV, compared to non-intubated patients (51, 33%, vs. 94, 18% respectively, p<0.001), and higher than that predicted by APACHE-II score (26%). IMV independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 3.54, 95% confidence interval 1.45±8.37, p = 0.006). Other independent predictors of mortality were septic shock, worse hypoxemia and increased serum potassium. Conclusion Invasive mechanical ventilation independently predicted 30-day mortality in patients with SCAP. Patients invasively ventilated should be considered a different population with higher mortality for future clinical trials on new interventions addressed to improve mortality of SCAP.

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