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Acute respiratory failure and severe sepsis may identify different clinical phenotypes in community-acquired pneumonia

Stefano Aliberti, Anna Maria Brambilla, James D. Chalmers, Catia Cilloniz, Angelo Bignamini, Elena Prina, Alice D'Adda, Marco Mantero, Alberto Pesci, Julio Ramirez, Antoni Torres, Francesco Blasi, Roberto Cosentini
European Respiratory Journal 2013 42: 4847; DOI:
Stefano Aliberti
1Health Science Department, University of Milan Bicocca, AO San Gerardo, Milan, Italy
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Anna Maria Brambilla
2Emergency Medicine Department, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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James D. Chalmers
3Tayside Respiratory Research Group, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
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Catia Cilloniz
4Department of Pneumology, Institut Clinic Del Tórax, Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Angelo Bignamini
5School of Specialization in Hospital Pharmacy, University OfMilan, Milan, Italy
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Elena Prina
2Emergency Medicine Department, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Alice D'Adda
6Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Marco Mantero
6Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Alberto Pesci
1Health Science Department, University of Milan Bicocca, AO San Gerardo, Milan, Italy
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Julio Ramirez
7Division of Infectious Diseases, Department of Internal Medicine, University of Louisville, Louisville, KY, United States
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Antoni Torres
4Department of Pneumology, Institut Clinic Del Tórax, Hospital Clinic of Barcelona - Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Francesco Blasi
6Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Roberto Cosentini
2Emergency Medicine Department, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract

The aim of the study was to evaluate the impact of acute respiratory failure (ARF) and severe sepsis (SS) on outcomes of patients with community-acquired pneumonia (CAP). This was a multicenter, observational, prospective study of immunocompetent CAP patients admitted to three hospitals in Italy, Spain and Scotland between 2008 and 2010. ARF was defined as the presence of at least one among: PaO2<60 mmHg; PaO2/FiO2 ratio<250; oxygen saturation<90%; respiratory acidosis. SS was defined according to the 2008 Surviving Sepsis Campaign. Three groups were identified: patients with neither ARF nor SS (Group 1), those with only ARF (Group 2) and those with both ARF and SS (Group 3) on admission. A total of 2,271 consecutive CAP patients were enrolled (48% male, mean±SD age 68±19 yrs). ARF and SS were diagnosed in 969 (49%) and 473 (21%) patients, respectively. 242 (11%) patients died during hospitalization. Prevalence and mortality according to the study groups are depicted in Figure. At the multivariable logistic regression model, after adjustment for centers and confounders, the presence of only ARF had an OR for mortality of 2.5 (95%CI: 1.6-4.0, p<0.001) and the presence of both ARF and SS an OR of 5.9 (95%CI: 3.6-9.8, p<0.001). The significant difference in mortality in patients with or without ARF and SS on admission may indicate different clinical phenotypes.

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  • Pneumonia
  • Sepsis
  • Acute respiratory failure
  • © 2013 ERS
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Acute respiratory failure and severe sepsis may identify different clinical phenotypes in community-acquired pneumonia
Stefano Aliberti, Anna Maria Brambilla, James D. Chalmers, Catia Cilloniz, Angelo Bignamini, Elena Prina, Alice D'Adda, Marco Mantero, Alberto Pesci, Julio Ramirez, Antoni Torres, Francesco Blasi, Roberto Cosentini
European Respiratory Journal Sep 2013, 42 (Suppl 57) 4847;

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Acute respiratory failure and severe sepsis may identify different clinical phenotypes in community-acquired pneumonia
Stefano Aliberti, Anna Maria Brambilla, James D. Chalmers, Catia Cilloniz, Angelo Bignamini, Elena Prina, Alice D'Adda, Marco Mantero, Alberto Pesci, Julio Ramirez, Antoni Torres, Francesco Blasi, Roberto Cosentini
European Respiratory Journal Sep 2013, 42 (Suppl 57) 4847;
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