Abstract
For patients with community-acquired pneumonia (CAP), clinical response during the first days of treatment is predictive of clinical outcome. As risk assessments can improve the efficiency of pneumonia management, a prospective cohort study to assess clinical, biochemical and microbiological predictors of early clinical failure was conducted in patients with severe CAP (pneumonia severity index score of >90 or according to the American Thoracic Society definition). Failure was assessed at day 3 and was defined as death, a need for mechanical ventilation, respiratory rate >25/min, PaO2 <55 mm Hg, oxygen saturation <90%, haemodynamic instability, temperature >38 degrees C or confusion. Of 260 patients, 80 (31%) had early clinical failure, associated mainly with a respiratory rate >25/minute (n = 34), oxygen saturation <90% (n = 28) and confusion (n = 20). In multivariate logistic regression analysis, failure was associated independently with altered mental state (OR 3.19, 95% CI 1.75-5.80), arterial PaH <7.35 mm Hg (OR 4.29, 95% CI 1.53-12.05) and PaO2 <60 mm Hg (OR 1.75, 95% CI 0.97-3.15). A history of heart failure was associated inversely with clinical failure (OR 0.30, 95% CI 0.10-0.96). Patients who failed to respond had a higher 28-day mortality rate and a longer hospital stay. It was concluded that routine clinical and biochemical information can be used to predict early clinical failure in patients with severe CAP.
Original language | English |
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Pages (from-to) | 1097-1104 |
Number of pages | 8 |
Journal | Clinical Microbiology and Infection |
Volume | 12 |
Issue number | 11 |
DOIs | |
Publication status | Published - Nov-2006 |
Externally published | Yes |
Keywords
- Academic Medical Centers
- Adolescent
- Adult
- Anti-Infective Agents
- Cohort Studies
- Community-Acquired Infections
- Female
- Hospitals, Teaching
- Humans
- Male
- Netherlands
- Pneumonia
- Prognosis
- Regression Analysis
- Risk Factors
- Severity of Illness Index
- Treatment Failure