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Original Research: CRITICAL CARE MEDICINE |

Late Admission to the ICU in Patients With Community-Acquired Pneumonia Is Associated With Higher Mortality

Marcos I. Restrepo, MD, MSc, FCCP; Eric M. Mortensen, MD, MSc; Jordi Rello, MD, PhD; Jennifer Brody, MD; Antonio Anzueto, MD
Author and Funding Information

From the Veterans Evidence Based Research Dissemination and Implementation Center (Drs Restrepo and Mortensen), Audie L. Murphy Division (Drs Restrepo, Mortensen, and Anzueto), South Texas Veterans Health Care System; the Department of Medicine, Divisions of General Medicine (Dr Mortensen) and Pulmonary and Critical Care Medicine (Drs Restrepo, Brody, and Anzueto), University of Texas Health Science Center at San Antonio, San Antonio, TX; the Servicio de Medicina Intensiva (Dr Rello), Hospital Universitario de Tarragona Joan XXIII; Instituto de Investigación Sanitaria Pere Virgili (Dr Rello); and the Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) and Universidad Rovira i Virgili (Dr Rello), Tarragona, Spain.

Correspondence to: Marcos I. Restrepo, MD, MSc, FCCP, VERDICT (11C6), South Texas Veterans Health Care System ALMD, 7400 Merton Minter Blvd, San Antonio, TX 78229; e-mail: restrepom@uthscsa.edu


Funding/Support: Dr Restrepo is supported by a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant and National Health Institute grant KL2 RR025766. Dr Mortensen was supported by Howard Hughes Medical Institute faculty-start up grant 00378-001 and a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):552-557. doi:10.1378/chest.09-1547
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Background:  Limited data are available on the impact of time to ICU admission and outcomes for patients with severe community acquired pneumonia (CAP). Our objective was to examine the association of time to ICU admission and 30-day mortality in patients with severe CAP.

Methods:  A retrospective cohort study of 161 ICU subjects with CAP (by International Classification of Diseases, 9th edition, codes) was conducted over a 3-year period at two tertiary teaching hospitals. Timing of the ICU admission was dichotomized into early ICU admission (EICUA, direct admission or within 24 h) and late ICU admission (LICUA, ≥ day 2). A multivariable analysis using Cox proportional hazard model was created with the primary outcome of 30-day mortality (dependent measure) and the American Thoracic Society (ATS) severity adjustment criteria and time to ICU admission as the independent measures.

Results:  Eighty-eight percent (n = 142) were EICUA patients compared with 12% (n = 19) LICUA patients. Groups were similar with respect to age, gender, comorbidities, clinical parameters, CAP-related process of care measures, and need for mechanical ventilation. LICUA patients had lower rates of ATS severity criteria at presentation (26.3% vs 53.5%; P = .03). LICUA patients (47.4%) had a higher 30-day mortality compared with EICUA (23.2%) patients (P = .02), which remained after adjusting in the multivariable analysis (hazard ratio 2.6; 95% CI, 1.2-5.5; P = .02).

Conclusion:  Patients with severe CAP with a late ICU admission have increased 30-day mortality after adjustment for illness severity. Further research should evaluate the risk factors associated and their impact on clinical outcomes in patients admitted late to the ICU.

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