Document Detail


Disease risk and mortality prediction in intensive care patients with pneumonia. Australian and New Zealand practice in intensive care (ANZPIC II).
MedLine Citation:
PMID:  15957699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58-1799, P<0.01), clinical signs of consolidation (OR 2.43, CI 95% 1.09-5.44, P=0.03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08-1.30, P<0.001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20-0.86, P=0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16-42.2, P=0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20-11.93, P=0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20-17.50, P<0.001), high SOFA scores (OR 1.44, CI 95% 1.20-1.75, P=0.001) and the isolation of "high risk" organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43-16.03, P=0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18-0.68, P=0.002). Mortality was similar for patients requiring both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P=0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.
Authors:
R J Boots; J Lipman; R Bellomo; D Stephens; R F Heller
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Anaesthesia and intensive care     Volume:  33     ISSN:  0310-057X     ISO Abbreviation:  Anaesth Intensive Care     Publication Date:  2005 Feb 
Date Detail:
Created Date:  2005-06-16     Completed Date:  2005-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0342017     Medline TA:  Anaesth Intensive Care     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  101-11     Citation Subset:  IM    
Affiliation:
Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Australia.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Community-Acquired Infections / classification,  mortality*
Comorbidity
Female
Humans
Intensive Care Units
Male
Middle Aged
Pneumonia / classification,  etiology,  mortality*
Predictive Value of Tests
Respiration, Artificial / adverse effects*
Risk Factors
Severity of Illness Index
Comments/Corrections
Comment In:
Anaesth Intensive Care. 2005 Feb;33(1):11-2   [PMID:  15957685 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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