PURPOSE: To determine the incidence, timing, and clinical outcomes of patients with community acqiured pneumonia who develop severe sepsis.
METHODS: This was a retrospective review of records of 528 patients admitted with community acqiured pneumonia (CAP) at the University of Louisville Hospital and the Veterans Affairs Medical Center of Louisville between 1997 and 2000. Patients who received appropriate antimicrobial treatment and met criteria for clinical failure and severe sepsis were included.
RESULTS: We reviewed 528 patients; clinical failure was identified in 13% of the patients (67/528). Severe sepsis as etiology of failure was present in 16/67 patients (24%). The mean age of patients was 62.5 yrs and there were 3 females (18.8%) and 13 males (81.2%). Severe sepsis developed on day of admission in 12 patients (75%), day one in 2 patients (12.5%), and day two in 2 patients (12.5%). The 90 day mortality was 43.7% (7/16). All patients with severe sepsis and clinical failure developed respiratory failure at day 1. All patients who died developed renal impairment and cardiovascular collapse at 48 hours. Patients who survived had more hematological dysfunction (44%) compared to those who died (29%). Disease severity indices were compared among survivors and non-survivors at 90 days (Table1).
CONCLUSION: In our patients, clinical deterioration occurred during the first 24 to 72 hours. The mortality rate (43.7%) was double the ones observed in CAP patients with high risk class (27% in class V). We did not find that the disease indices could predict outcome. However, Delta SOFA score at 48 hours was higher in patients who died( 4.7 vs. 2).
CLINICAL IMPLICATIONS: In hospitalized patients with CAP, clinical deterioration occurs during the first 24 to 72 hours even with effective antimicrobial treatment. Indices of disease severity might fail to predict the clinical course.
DISCLOSURE: Fidaa Shaib, No Financial Disclosure Information; No Product/Research Disclosure Information