By Dr Yung Sai Kwong, QEH
Background: Community acquired pneumonia (CAP) is a common cause of intensive care unit (ICU) admission. The aim of this study was to identify factors predicting 30-day mortality and to describe the patient characteristics and aetiologies in patients admitted to the ICU for severe CAP.
Methods: This was a single centre retrospective study. Demographic data, treatment methods, aetiologies and outcomes of patients admitted to the ICU of Queen Elizabeth Hospital for severe CAP from 1st January 2011 to 30th June 2013 were analysed.
Results: 116 eligible patients were identified. The 30-day mortality rate was 28% (32 patients). Older age (adjusted OR 1.06 per year increase, 95% CI 1.02 – 1.11), need for renal replacement therapy (adjusted OR 12.1, 95% CI 3.92 – 37.4) and admission to ICU during weekends or public holidays (adjusted OR 4.16, 95% CI 1.26 – 13.7, compared to admission during office hours) were independent predictors of 30-day mortality on multivariate logistic regression analysis. Among the pneumonia-specific severity scores examined, pneumonia severity index was most predictive of 30-day mortality (AUC = 0.70 on ROC curve). For the general ICU severity scores, APACHE II and IV had the same performance in predicting 30-day mortality, both with AUC 0.84 on ROC curves. Of the 80 (71%) patients with an identifiable aetiology, influenza (34 patients, 29.3%) and pneumococcus (30 patients, 25.9%) were the most common.
Conclusions: Older age, need for renal replacement therapy and admission to ICU during weekends or public holidays were independent predictors of 30-day mortality in patients admitted for severe CAP.