Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality.
Chest. 2009 Oct 31;
Authors: Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A
BACKGROUND: Limited data are available on the impact of time to ICU admission and outcomes for patients with severe community acquired pneumonia (CAP). Our objective was to examine the association of time to ICU admission and 30-day mortality in severe CAP patients. METHODS: A retrospective cohort study of 161 ICU CAP subjects (by ICD-9 codes) was conducted over a three year period at two tertiary teaching hospitals. Timing of the ICU admission was dichotomized into early ICU admission (EICUA - direct admission or within 24 hours) and late ICU admission (LICUA - >/=day 2). A multivariable analysis using Cox proportional hazard model was created with the primary outcome of 30-day mortality (dependent measure), and the American Thoracic Society (ATS) severity adjustment criteria and time to ICU admission as the independent measures. RESULTS: Eighty-eight percent (n=142) were EICUA compared to 12% (n=19) LICUA patients. Groups were similar with respect to age, gender, comorbidities, clinical parameters, and CAP-related process of care measures, and need for mechanical ventilation. LICUA patients had lower rates of ATS severity criteria at presentation (26.3% vs. 53.5%; p=0.03). LICUA patients (47.4%) had a higher 30-day mortality compared to EICUA (23.2%) patients (p=0.02), and remained after adjusting in the multivariable analysis (Hazard ratio 2.6, 95% Confidence Interval 1.2-5.5; p=0.02). CONCLUSION: Severe CAP patients with a late ICU admission have increased 30-day mortality after adjustment for severity of illness. Further research should evaluate the risk factors associated and their impact on clinical outcomes in patients admitted late to the ICU.
PMID: 19880910 [PubMed - as supplied by publisher]