Abstract
Although clinical failure is one of the most relevant outcomes in CAP patients, there is little discussion in literature on its incidence and etiology. The aim of the study was to evaluate incidence, risk factors and outcomes of CAP patients undergoing a clinical failure during hospitalization. An international, multicenter, prospective, observational study was performed from October 2009 to December 2010 in 8 Respiratory Dpts, enrolling consecutive patients hospitalized with CAP (ClinicalTrials: NCT01143155). Clinical failure was defined as either acute pulmonary or hemodynamic deterioration or in-hospital death. Risk factors associated to the development of clinical failure were analyzed by a multivariable analysis. Among the 431 patients enrolled (56% males; mean±SD age:73±16 yrs), incidence of clinical failures was 17% (72 patients). The majority of the clinical failures were related to the pneumonia. The development of cardiovascular events was significantly higher in patients who failed in comparison to the rest of the population (36% vs. 17%, respectively, p<0.001). At the multivariable analysis the only risk factor independently associated to the development of clinical failure during hospitalization was the severity of the disease on admission evaluated with the PSI. Mortality at 30 days after the diagnosis of the pneumonia was significantly higher among patients who failed in comparison to the rest of the population (72% vs.4%, respectively, p<0.001). A better understanding of clinical failure would be useful in order to prevent complications during the hospitalization, to develop new treatment modalities and, thus, to improve outcomes.
- © 2011 ERS