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Original Research: Critical Care |

Hypocapnia and Hypercapnia Are Predictors for ICU Admission and Mortality in Hospitalized Patients With Community-Acquired PneumoniaPaco2 Is a Predictor of Mortality in Pneumonia

Elena Laserna, MD; Oriol Sibila, MD; Patrick R. Aguilar, MD; Eric M. Mortensen, MD; Antonio Anzueto, MD; Jose M. Blanquer, MD; Francisco Sanz, MD; Jordi Rello, MD; Pedro J. Marcos, MD; Maria I. Velez, MD; Nivin Aziz, MD; Marcos I. Restrepo, MD, FCCP
Author and Funding Information

From the University of Texas Health Science Center at San Antonio (Drs Laserna, Sibila, Aguilar, Anzueto, Velez, Aziz, and Restrepo), San Antonio, TX; Servei de Pneumologia (Dr Laserna), Hospital Comarcal de Mollet, Mollet del Valles, Spain; Servei de Pneumologia Hospital de la Santa Creui Sant Pau (Dr Sibila), Barcelona, Spain; the VA North Texas Health Care System and the University of Texas Southwestern Medical Center (Dr Mortensen), Dallas, TX; the South Texas Veterans Health Care System (Drs Anzueto, Velez, and Restrepo), San Antonio, TX; Unidad de Cuidados Intensivos Respiratorios Hospital Clinic Universitari (Dr Blanquer), Valencia, Spain; Servicio de Neumologia (Dr Sanz), Consorci Hospital General Universitari, Valencia, Spain; Servei de Medicina Intensiva (Dr Rello), Hospital de la Vall d’ Hebron, CIBERES, VHICU, Universitat Autonoma de Barcelona, Barcelona, Spain; Servicio de Neumologia Complejo Hospitalario Universitario de A Coruna (Dr Marcos), A Coruna, Spain; and the Veterans Evidence Based Research Dissemination and Implementation Center (VERDICT) Dr Restrepo, San Antonio, TX.

Correspondence to: Marcos I. Restrepo, MD, 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: This research was supported by a Howard Hughes Medical Institute faculty start-up grant [00378-001] and a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant. Drs Laserna and Sibila are supported by Sociedad Espanola de Neumologia y Cirugia Toracica, Societat Catalana de Pneumologia, and Fundacio Catalana de Pneumologia. Dr Sibila is supported by Instituto de Salud Carlos III [Grant BAE11/00102]. Dr Restrepo’s time is partially protected by an award from the National Heart, Lung, and Blood Institute [K23HL096054].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1193-1199. doi:10.1378/chest.12-0576
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Objective:  The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal Paco2 and ICU admission and 30-day mortality.

Methods:  A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of Paco2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures.

Results:  Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal Paco2 (35-45 mm Hg), 194 patients (42%) had a Paco2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a Paco2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal Paco2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups.

Conclusion:  In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, Paco2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.

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