Abstract
Background: The etiology of clinical failure in hospitalized patients with community-acquired pneumonia (CAP) may be related or unrelated to pulmonary infection. The objective of this study was to define the incidence, etiology, timing, and risk factors associated with clinical failures related to CAP vs those unrelated to CAP. Methods: Observational retrospective study of consecutive CAP patients. All patients who experienced clinical failure were identified. Cases were presented to a review committee that defined, by consensus, etiology, timing, and risk factors for clinical failures related to CAP. Results: Among 500 patients who were enrolled in the study, clinical failure was identified in 67 (13%). Clinical failure was related to CAP in 54 patients (81%). The most common etiologies for clinical failure related to CAP were severe sepsis (33%), acute myocardial infarction (28%), and progressive pneumonia (19%). All cases of severe sepsis occurred in the first 72 h of hospitalization. The most common etiology for clinical failure unrelated to CAP was the development of hospital-acquired pneumonia (45%). At the time of hospital admission, factors associated with clinical failure related to CAP were advanced age, congestive heart failure, hypotension, abnormal gas exchange, acidosis, hypothermia, thrombocytopenia, and pleural effusion. Conclusions: The development of severe sepsis early during hospitalization is the primary etiology for clinical failure related to CAP. To achieve early treatment intervention, physicians should maintain a high index of suspicion for severe sepsis in hospitalized patients with CAP. To decrease the number of clinical failures unrelated to CAP, interventions need to be developed at the local level to improve the processes of care for patients with pneumonia.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 955-962 |
| Number of pages | 8 |
| Journal | Chest |
| Volume | 134 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2008 |
| Externally published | Yes |
Fingerprint
Keywords
- Pneumonia
- Respiratory failure
- Septic shock
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. / Aliberti, Stefano; Amir, Asad; Peyrani, Paula; Mirsaeidi, Mehdi; Allen, Marty; Moffett, Brian K.; Myers, John; Shaib, Fidaa; Cirino, Maria; Bordon, Jose; Blasi, Francesco; Ramirez, Julio A.
In: Chest, Vol. 134, No. 5, 11.2008, p. 955-962.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia
AU - Aliberti, Stefano
AU - Amir, Asad
AU - Peyrani, Paula
AU - Mirsaeidi, Mehdi
AU - Allen, Marty
AU - Moffett, Brian K.
AU - Myers, John
AU - Shaib, Fidaa
AU - Cirino, Maria
AU - Bordon, Jose
AU - Blasi, Francesco
AU - Ramirez, Julio A.
PY - 2008/11
Y1 - 2008/11
N2 - Background: The etiology of clinical failure in hospitalized patients with community-acquired pneumonia (CAP) may be related or unrelated to pulmonary infection. The objective of this study was to define the incidence, etiology, timing, and risk factors associated with clinical failures related to CAP vs those unrelated to CAP. Methods: Observational retrospective study of consecutive CAP patients. All patients who experienced clinical failure were identified. Cases were presented to a review committee that defined, by consensus, etiology, timing, and risk factors for clinical failures related to CAP. Results: Among 500 patients who were enrolled in the study, clinical failure was identified in 67 (13%). Clinical failure was related to CAP in 54 patients (81%). The most common etiologies for clinical failure related to CAP were severe sepsis (33%), acute myocardial infarction (28%), and progressive pneumonia (19%). All cases of severe sepsis occurred in the first 72 h of hospitalization. The most common etiology for clinical failure unrelated to CAP was the development of hospital-acquired pneumonia (45%). At the time of hospital admission, factors associated with clinical failure related to CAP were advanced age, congestive heart failure, hypotension, abnormal gas exchange, acidosis, hypothermia, thrombocytopenia, and pleural effusion. Conclusions: The development of severe sepsis early during hospitalization is the primary etiology for clinical failure related to CAP. To achieve early treatment intervention, physicians should maintain a high index of suspicion for severe sepsis in hospitalized patients with CAP. To decrease the number of clinical failures unrelated to CAP, interventions need to be developed at the local level to improve the processes of care for patients with pneumonia.
AB - Background: The etiology of clinical failure in hospitalized patients with community-acquired pneumonia (CAP) may be related or unrelated to pulmonary infection. The objective of this study was to define the incidence, etiology, timing, and risk factors associated with clinical failures related to CAP vs those unrelated to CAP. Methods: Observational retrospective study of consecutive CAP patients. All patients who experienced clinical failure were identified. Cases were presented to a review committee that defined, by consensus, etiology, timing, and risk factors for clinical failures related to CAP. Results: Among 500 patients who were enrolled in the study, clinical failure was identified in 67 (13%). Clinical failure was related to CAP in 54 patients (81%). The most common etiologies for clinical failure related to CAP were severe sepsis (33%), acute myocardial infarction (28%), and progressive pneumonia (19%). All cases of severe sepsis occurred in the first 72 h of hospitalization. The most common etiology for clinical failure unrelated to CAP was the development of hospital-acquired pneumonia (45%). At the time of hospital admission, factors associated with clinical failure related to CAP were advanced age, congestive heart failure, hypotension, abnormal gas exchange, acidosis, hypothermia, thrombocytopenia, and pleural effusion. Conclusions: The development of severe sepsis early during hospitalization is the primary etiology for clinical failure related to CAP. To achieve early treatment intervention, physicians should maintain a high index of suspicion for severe sepsis in hospitalized patients with CAP. To decrease the number of clinical failures unrelated to CAP, interventions need to be developed at the local level to improve the processes of care for patients with pneumonia.
KW - Pneumonia
KW - Respiratory failure
KW - Septic shock
UR - http://www.scopus.com/inward/record.url?scp=55849127448&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=55849127448&partnerID=8YFLogxK
U2 - 10.1378/chest.08-0334
DO - 10.1378/chest.08-0334
M3 - Article
C2 - 18583514
AN - SCOPUS:55849127448
VL - 134
SP - 955
EP - 962
JO - Chest
JF - Chest
SN - 0012-3692
IS - 5
ER -