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Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia

  1. M. Hoogewerf1,
  2. J. J. Oosterheert1,
  3. E. Hak2,
  4. I. M. Hoepelman1,3,
  5. M. J. M. Bonten1,2,3

Article first published online: 3 AUG 2006

DOI: 10.1111/j.1469-0691.2006.01535.x

Issue

Clinical Microbiology and Infection

Clinical Microbiology and Infection

Volume 12, Issue 11, pages 1097–1104, November 2006

Additional Information

How to Cite

Hoogewerf, M., Oosterheert, J., Hak, E., Hoepelman, I. and Bonten, M. (2006), Prognostic factors for early clinical failure in patients with severe community-acquired pneumonia. Clinical Microbiology and Infection, 12: 1097–1104. doi: 10.1111/j.1469-0691.2006.01535.x

Author Information

  1. 1

    Department of Internal Medicine and Infectious Diseases

  2. 2

    Julius Center for Health Sciences and Primary Care

  3. 3

    Eijkman Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, The Netherlands

*Corresponding author and reprint requests: M. J. M. Bonten, University Medical Center, Department of Internal Medicine and Infectious Diseases, Room F02-126, PO Box 85500, 3508 GA Utrecht, The Netherlands E-mail: mbonten@umcutrecht.nl

Publication History

  1. Issue published online: 3 AUG 2006
  2. Article first published online: 3 AUG 2006
  3. Original Submission: 27 October 2005; Revised Submission: 1 March 2006; Accepted: 15 April 2006

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Keywords:

  • Clinical failure;
  • community-acquired pneumonia;
  • management;
  • outcome;
  • prognosis;
  • risk-factors

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°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.

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