Underlying illness severity and outcome of nosocomial pneumonia: prospective cohort study in intensive care unit
| Autor: | R. Fernández-Crehuet Navajas, B. Guzmán-Herrador, C. Díaz Molina, Mohamed Farouk Allam |
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| Rok vydání: | 2013 |
| Předmět: |
Microbiology (medical)
Adult Male Pediatrics medicine.medical_specialty Multivariate analysis Logistic regression Severity of Illness Index law.invention Cohort Studies Hospitals University law medicine Humans Prospective Studies Prospective cohort study Aged Aged 80 and over Cross Infection APACHE II business.industry General Medicine Pneumonia Middle Aged medicine.disease Intensive care unit Survival Analysis Confidence interval Intensive Care Units Infectious Diseases Treatment Outcome Spain Emergency medicine Multivariate Analysis Female business Cohort study |
| Zdroj: | The Journal of hospital infection. 86(1) |
| ISSN: | 1532-2939 |
| Popis: | Summary Background Previous studies have suggested that the final outcome of a patient with nosocomial pneumonia (NP) may depend on the patient's illness severity upon admission to the intensive care unit (ICU). Aim To investigate the relationship between developing NP during hospitalization in an adult ICU and the risk of death with special focus on illness severity at admission in the unit. Methods A prospective cohort study was performed among all patients admitted for at least 24h to the ICU of a university reference hospital in Spain from 2006 to 2009. A stratified univariate study was performed according to the patients' illness severity at admission, estimated using the Acute Physiology And Chronic Health Evaluation (APACHE) II index. To determine whether the NP was independently associated with increased mortality in ICU, a multivariate logistic regression analysis was carried out, adjusting for potential confounders. Results In all, 4427 patients were studied, of whom 233 acquired NP while admitted. Patients who developed NP had a 2.6 higher risk (95% confidence interval: 2.1–3.0) of dying compared with those who did not develop NP. When stratified by the APACHE II index, the significant association remained at each stratum, although the strength of the association decreased as the value of the index increased. In the multivariate analysis, NP was independently associated with death in the ICU. The interaction between NP and the APACHE II index, with a negative coefficient, was also significant. Conclusions Developing NP while admitted to the ICU was independently associated with increased mortality. However, the strength of the association decreased as the severity of patient illness upon admission to the ICU increased, not influencing death of patients with severe APACHE II values. |
| Databáze: | OpenAIRE |
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