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Risk factors for mortality in patients admitted to intensive care units with pneumonia.

Publication ,  Journal Article
Li, G; Cook, DJ; Thabane, L; Friedrich, JO; Crozier, TM; Muscedere, J; Granton, J; Mehta, S; Reynolds, SC; Lopes, RD; Lauzier, F; Freitag, AP ...
Published in: Respir Res
July 11, 2016

BACKGROUND: Despite the high mortality in patients with pneumonia admitted to an ICU, data on risk factors for death remain limited. METHODS: In this secondary analysis of PROTECT (Prophylaxis for Thromboembolism in Critical Care Trial), we focused on the patients admitted to ICU with a primary diagnosis of pneumonia. The primary outcome for this study was 90-day hospital mortality and the secondary outcome was 90-day ICU mortality. Cox regression model was conducted to examine the relationship between baseline and time-dependent variables and hospital and ICU mortality. RESULTS: Six hundred sixty seven patients admitted with pneumonia (43.8 % females) were included in our analysis, with a mean age of 60.7 years and mean APACHE II score of 21.3. During follow-up, 111 patients (16.6 %) died in ICU and in total, 149 (22.3 %) died in hospital. Multivariable analysis demonstrated significant independent risk factors for hospital mortality including male sex (hazard ratio (HR) = 1.5, 95 % confidence interval (CI): 1.1 - 2.2, p-value = 0.021), higher APACHE II score (HR = 1.2, 95 % CI: 1.1 - 1.4, p-value < 0.001 for per-5 point increase), chronic heart failure (HR = 2.9, 95 % CI: 1.6 - 5.4, p-value = 0.001), and dialysis (time-dependent effect: HR = 2.7, 95 % CI: 1.3 - 5.7, p-value = 0.008). Higher APACHE II score (HR = 1.2, 95 % CI: 1.1 - 1.4, p-value = 0.002 for per-5 point increase) and chronic heart failure (HR = 2.6, 95 % CI: 1.3 - 5.0, p-value = 0.004) were significantly related to risk of death in the ICU. CONCLUSION: In this study using data from a multicenter thromboprophylaxis trial, we found that male sex, higher APACHE II score on admission, chronic heart failure, and dialysis were independently associated with risk of hospital mortality in patients admitted to ICU with pneumonia. While high illness severity score, presence of a serious comorbidity (heart failure) and need for an advanced life support (dialysis) are not unexpected risk factors of mortality, male sex might necessitate further exploration. More studies are warranted to clarify the effect of these risk factors on survival in critically ill patients admitted to ICU with pneumonia. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00182143 .

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Published In

Respir Res

DOI

EISSN

1465-993X

Publication Date

July 11, 2016

Volume

17

Issue

1

Start / End Page

80

Location

England

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Risk Factors
  • Respiratory System
  • Renal Dialysis
  • Proportional Hazards Models
  • Pneumonia
  • Patient Admission
  • Multivariate Analysis
  • Middle Aged
 

Citation

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Li, G., Cook, D. J., Thabane, L., Friedrich, J. O., Crozier, T. M., Muscedere, J., … PROTECT Investigators for the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. (2016). Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res, 17(1), 80. https://doi.org/10.1186/s12931-016-0397-5
Li, Guowei, Deborah J. Cook, Lehana Thabane, Jan O. Friedrich, Tim M. Crozier, John Muscedere, John Granton, et al. “Risk factors for mortality in patients admitted to intensive care units with pneumonia.Respir Res 17, no. 1 (July 11, 2016): 80. https://doi.org/10.1186/s12931-016-0397-5.
Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, et al. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res. 2016 Jul 11;17(1):80.
Li, Guowei, et al. “Risk factors for mortality in patients admitted to intensive care units with pneumonia.Respir Res, vol. 17, no. 1, July 2016, p. 80. Pubmed, doi:10.1186/s12931-016-0397-5.
Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, Granton J, Mehta S, Reynolds SC, Lopes RD, Lauzier F, Freitag AP, Levine MAH, PROTECT Investigators for the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res. 2016 Jul 11;17(1):80.

Published In

Respir Res

DOI

EISSN

1465-993X

Publication Date

July 11, 2016

Volume

17

Issue

1

Start / End Page

80

Location

England

Related Subject Headings

  • Time Factors
  • Sex Factors
  • Risk Factors
  • Respiratory System
  • Renal Dialysis
  • Proportional Hazards Models
  • Pneumonia
  • Patient Admission
  • Multivariate Analysis
  • Middle Aged