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Original Research |

Radiologic Progression of Pulmonary Infiltrates Predicts a Worse Prognosis in Severe Community-Acquired Pneumonia Than Bacteremia

Thiago Lisboa, MD; Stijn Blot, PhD; Grant W. Waterer, MD, PhD; Emili Canalis, MD, PhD, FCCP; Diego de Mendoza, MD; Alejandro Rodriguez, MD, PhD; Jordi Rello, MD, PhD*; for the Community-Acquired Pneumonia Intensive Care Units Study Investigators
Author and Funding Information

*From the Critical Care Department (Drs. Lisboa, Rodriguez, and Rello), Joan XXIII University Hospital & University Rovira i Virgili, Ciber Enfermedades Respiratorias, Tarragona, Spain; Department of Infectious Diseases (Dr. Blot), Ghent University Hospital; Faculty of Healthcare, Ghent University College; Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium; School of Medicine and Pharmacology (Dr. Waterer), University of Western Australia, Perth, WA, Australia; Thoracic Surgery Department (Dr. Canalis), Hospital Clinic, Ciber Enfermedades Respiratorias, Barcelona, Spain; and Intensive Care Department (Dr. de Mendoza), Parc Tauli Hospital, Ciber Enfermedades Respiratorias, Sabadell, Spain.

Correspondence to: Jordi Rello, MD, PhD, Critical Care Department, Joan XXIII University Hospital, CIBER Enfermedades Respiratorias, Carrer Mallafre Guasch, 4 43007 Tarragona, Spain; e-mail: jrello.hj23.ics@gencat.cat

†A list of participants is given in the Appendix.

*Data are expressed as No. (%) or median (interquartile range). Group RB = patients with rapid radiographic spread of pulmonary infiltrates and bacteremia; Group R = patients with rapid radiographic spread of pulmonary infiltrates only; Group B = patients with bacteremia only; Group C = patients with neither rapid radiographic spread of pulmonary infiltrates nor bacteremia.

†In patients with definite etiology.

‡p Value for analysis of variance and χ2 comparisons among the four groups.

*See Table 1 footnote for description of terms.

*See Table 1 footnote for description of terms.

Dr. Lisboa and Dr. Blot are the joint primary authors.

Financial support was provided by FISS (PI 04/1500), FISS (05/2401), SGR 05/920, and CB 06/06/036.

The authors do not have any conflicts of interest to declare.

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


Dr. Lisboa and Dr. Blot are the joint primary authors.

Dr. Lisboa and Dr. Blot are the joint primary authors.

Financial support was provided by FISS (PI 04/1500), FISS (05/2401), SGR 05/920, and CB 06/06/036.

Financial support was provided by FISS (PI 04/1500), FISS (05/2401), SGR 05/920, and CB 06/06/036.

The authors do not have any conflicts of interest to declare.

The authors do not have any conflicts of interest to declare.

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

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


Chest. 2009;135(1):165-172. doi:10.1378/chest.08-1216
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Background:  It remains unknown whether bacteremia and rapid radiologic progression of pulmonary infiltrates increase the risk of shock and mortality in ICU patients with community-acquired pneumonia (CAP). The objective of this study was to investigate the relative importance of these two factors in the outcome of patients with severe CAP (sCAP).

Methods:  A secondary analysis in a multicenter observational study was conducted in 457 patients with CAP admitted to the ICU. Patients were classified into four groups: group RB, rapid radiographic spread of pulmonary infiltrates and bacteremia (n = 48); group R, rapid radiographic spread but no bacteremia (n = 183); group B, bacteremia but without rapid radiographic spread (n = 39); and group C, neither rapid radiographic spread nor bacteremia (n = 187).

Results:  Logistic regression analysis showed that group RB and group R had a greater risk for shock than group C (adjusted odds ratio [aOR], 8.9; 95% confidence interval [CI], 4.0 to 19.7; and aOR, 3.8; 95% CI, 2.5 to 5.9; respectively), while patients in group B had no increased risk. In addition, compared to group C, group RB and group R had an increased risk of ICU death (aOR, 3.4; 95% CI, 1.4 to 8.1; and aOR, 3.1; 95% CI, 1.7 to 5.7, respectively), while patients in group B had none.

Conclusions:  In this cohort of patients with severe CAP, radiologic progression of pulmonary infiltrates in the first 48 h is a significant adverse prognostic feature. In contrast, bacteremia does not affect outcomes.

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