Rationale:
Hospital-acquired pneumonia (HAP) is one of the most frequent infections among patients in the hospital. The mortality of patients with HAP is higher than that of community-acquired pneumonia (CAP). There are several severity scoring systems for CAP (ex. PSI, CURB-65 and A-DROP), and physicians widely use them in clinical settings. However, evidence is insufficient regarding the risk factors for severe adverse outcomes in patients with HAP. Thus, physicians have assessed whether patients with HAP would develop adverse outcomes without validated predictive rules, and have decided site of care in individual cases. The aim of this study is to clarify the risk factors for severe adverse outcomes in patients with HAP so that physicians can make the appropriate site-of-care decisions at diagnosis.
Methods:
This prospective, observational study was conducted in adult patients with HAP (excluded ventilator-associated pneumonia) at Nagoya University Hospital from March 15, 2010 through March 31, 2016. Severe adverse outcomes were defined as any of the following events during 30 days after diagnosis: death, admission to the intensive care unit (ICU), receiving mechanical ventilation support including invasive and noninvasive positive pressure ventilation, and receiving vasopressor support. Patients who were treated in the ICU, or with mechanical ventilation or vasopressor support at diagnosis were excluded from this analysis. Using multivariate logistic regression analysis with a forward stepwise selection procedure, we assessed the risk factors for severe adverse outcomes. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were calculated.
Results:
In total, 314 patients with HAP were analyzed, and 54 (17.2%) of them developed severe adverse outcomes. Significant risk factors for severe adverse outcomes included PaO2/FiO2 ratio ≤ 200 (adjusted OR: 5.67, 95% CI: 2.42–13.30), albumin < 2.0 g/dl (4.83, 1.83–12.76), congestive heart failure (4.73, 1.79–12.54), total extension of chest X-ray infiltration over two-thirds of one lung (4.04, 1.60–10.19), and serum sodium level < 130 mEq/l or ≥ 150 mEq/l (3.40, 1.37–8.41). Although statistical significance was not obtained, the following factors also tended to increase the risk of severe adverse outcomes: pulse rate ≥ 125 /min (3.40, 0.83–13.86), neoplastic diseases (2.25, 0.99–5.12), and age ≥ 70 (2.14, 0.99–4.59).
Conclusions:
We elucidated the risk factors for severe adverse outcomes in patients with HAP. Patients with these factors at diagnosis are at increased risk of severe adverse outcomes. Therefore, physicians should treat those patients more carefully considering the ICU care.
Hospital-acquired pneumonia (HAP) is one of the most frequent infections among patients in the hospital. The mortality of patients with HAP is higher than that of community-acquired pneumonia (CAP). There are several severity scoring systems for CAP (ex. PSI, CURB-65 and A-DROP), and physicians widely use them in clinical settings. However, evidence is insufficient regarding the risk factors for severe adverse outcomes in patients with HAP. Thus, physicians have assessed whether patients with HAP would develop adverse outcomes without validated predictive rules, and have decided site of care in individual cases. The aim of this study is to clarify the risk factors for severe adverse outcomes in patients with HAP so that physicians can make the appropriate site-of-care decisions at diagnosis.
Methods:
This prospective, observational study was conducted in adult patients with HAP (excluded ventilator-associated pneumonia) at Nagoya University Hospital from March 15, 2010 through March 31, 2016. Severe adverse outcomes were defined as any of the following events during 30 days after diagnosis: death, admission to the intensive care unit (ICU), receiving mechanical ventilation support including invasive and noninvasive positive pressure ventilation, and receiving vasopressor support. Patients who were treated in the ICU, or with mechanical ventilation or vasopressor support at diagnosis were excluded from this analysis. Using multivariate logistic regression analysis with a forward stepwise selection procedure, we assessed the risk factors for severe adverse outcomes. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were calculated.
Results:
In total, 314 patients with HAP were analyzed, and 54 (17.2%) of them developed severe adverse outcomes. Significant risk factors for severe adverse outcomes included PaO2/FiO2 ratio ≤ 200 (adjusted OR: 5.67, 95% CI: 2.42–13.30), albumin < 2.0 g/dl (4.83, 1.83–12.76), congestive heart failure (4.73, 1.79–12.54), total extension of chest X-ray infiltration over two-thirds of one lung (4.04, 1.60–10.19), and serum sodium level < 130 mEq/l or ≥ 150 mEq/l (3.40, 1.37–8.41). Although statistical significance was not obtained, the following factors also tended to increase the risk of severe adverse outcomes: pulse rate ≥ 125 /min (3.40, 0.83–13.86), neoplastic diseases (2.25, 0.99–5.12), and age ≥ 70 (2.14, 0.99–4.59).
Conclusions:
We elucidated the risk factors for severe adverse outcomes in patients with HAP. Patients with these factors at diagnosis are at increased risk of severe adverse outcomes. Therefore, physicians should treat those patients more carefully considering the ICU care.