Chest
Original ResearchPneumoniaIncidence, Etiology, Timing, and Risk Factors for Clinical Failure in Hospitalized Patients With Community-Acquired Pneumonia
Section snippets
Study Design and Study Patients
This was an observational, retrospective study of consecutive patients who were admitted with a diagnosis of CAP to the Veterans Affairs Medical Center of Louisville, KY, between June 2001 and March 2006. Patients enrolled in this study are part of the Community-Acquired Pneumonia Organization database.10 The study protocol and data collection form are available on the study Web site (www.caposite.com). The institutional review board of the Veterans Affairs Medical Center approved the study.
Incidence of Clinical Failure
From a total of 500 consecutive patients with CAP who were enrolled during the study period, 67 patients (13%) met at least one of the three criteria for clinical failure. The clinical failure criteria for acute pulmonary deterioration were fulfilled in 39 patients (8%), those for acute hemodynamic deterioration were fulfilled in 10 patients (2%), and those for in-hospital death were fulfilled in 36 patients (7%). Some patients met more than one criterion on the day that clinical failure was
Discussion
This study indicates that > 80% of the causes of clinical failure in hospitalized patients with CAP are directly related to pulmonary infection and its systemic inflammatory response. Clinical failures related to CAP occur primarily during the first 72 h after hospital admission, and severe sepsis is the primary etiology of clinical failure related to CAP. The independent risk factors at the time of hospital admission associated with clinical failure related to CAP found in the study population
Acknowledgment
The authors acknowledge the assistance of Raul Nakamatsu MD, Forest Arnold, MD, and Mary Elizabeth Allen, MBA (Division of Infectious Diseases, University of Louisville); and Elizabeth Smigielski, MSLS (Associate Professor, Kornhauser Health Sciences Library, University of Louisville).
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The work was performed in the Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY.
This work was accepted as oral communication at the European Respiratory Society Annual Congress 2007.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).