RT Journal Article
SR Electronic
T1 Severe community-acquired pneumonia: Characteristics and prognostic factors in ventilated and non-ventilated patients
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP OA3025
DO 10.1183/13993003.congress-2016.OA3025
VO 48
IS suppl 60
A1 Ferrer Monreal, Miquel
A1 Travierso, Chiara
A1 Cilloniz, Catia
A1 Gabarrus, Albert
A1 Polverino, Eva
A1 Liapikou, Adamantia
A1 Blasi, Francesco
A1 Torres, Antoni
YR 2016
UL http://erj.ersjournals.com/content/48/suppl_60/OA3025.abstract
AB Background: Severe community-acquired pneumonia (SCAP) is associated with significant morbidity and mortality. Patients with SCAP and life-threatening acute respiratory failure may require invasive mechanical ventilation (IMV); however, there is limited information on these patients.Methods: We prospectively studied consecutive patients with SCAP. We assessed the characteristics and outcomes of patients on IMV, compared with those who needed non-invasive ventilation (NIV) and no ventilatory support, and determined predictors for mortality and evolution of mortality over time in this population.Results: Among 3,719 patients diagnosed of CAP during 12 years, 664 (18%) had criteria for SCAP; 154 (23%) were allocated to the IMV group, 94 (14%) to the NIV group, and 416 (63%) did not require any ventilatory support; 198 (30%) presented septic shock. In 370 (56%) cases the diagnosis of SCAP was based solely on the presence of 3 or more IDSA/ATS minor criteria. Streptococcus pneumoniae was the main pathogen in all groups. The 30-day mortality was higher in the IMV, compared to the NIV and non-ventilated groups (51, 33%, vs. 17, 18% and 77, 19%, respectively, p=0·001). IMV, but neither NIV nor shock, independently predicted 30-day mortality in multivariate analysis (adjusted odds-ratio 2.18, 95% confidence interval 1·12-4·24, p=0·022). The 30-day mortality did not significantly change over time during the study period.Conclusion: The need for IMV independently predicted 30-day mortality in patients with SCAP. Patients needing IMV should be a target population for future clinical trials on new interventions addressed to improve mortality of SCAP.