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

Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, Granton J, Mehta S, Reynolds SC, Lopes RD, Francois L, Freitag AP, Levine MA, PROTECT Investigators for the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Gro - Respir. Res. (2016)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 501-25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. lig28@mcmaster.ca.

ABSTRACT

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 .

No MeSH data available.


Related in: MedlinePlus

KM curve for 90-day Hospital mortality
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4940754&req=5

Fig1: KM curve for 90-day Hospital mortality

Mentions: Of the 667 patients during follow-up, 149 patients (22.3 %) died in hospital in total. The median hospital stay for survivors was 17 days (IQR: 10–30), and 15 days (IQR: 8–26) for non-survivors. Figure 1 displays the Kaplan-Meier survival curves for 90-day hospital mortality. Table 1 shows the unadjusted comparison between hospital survivors and non-survivors. At baseline, non-survivors were significantly older, were more likely to be male, and had higher APACHE II scores than survivors. More non-survivors had end-stage renal disease, chronic respiratory disease and heart failure. Within the first 24 h, hospital non-survivors were more likely to have received inotropes or vasopressors, dialysis, central venous catheterization, and acetylsalicylic acid or clopidogrel than survivors (p-values < 0.05) (Table 1).Fig. 1


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

Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, Granton J, Mehta S, Reynolds SC, Lopes RD, Francois L, Freitag AP, Levine MA, PROTECT Investigators for the Canadian Critical Care Trials Group, and the Australian and New Zealand Intensive Care Society Clinical Trials Gro - Respir. Res. (2016)

KM curve for 90-day Hospital mortality
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940754&req=5

Fig1: KM curve for 90-day Hospital mortality
Mentions: Of the 667 patients during follow-up, 149 patients (22.3 %) died in hospital in total. The median hospital stay for survivors was 17 days (IQR: 10–30), and 15 days (IQR: 8–26) for non-survivors. Figure 1 displays the Kaplan-Meier survival curves for 90-day hospital mortality. Table 1 shows the unadjusted comparison between hospital survivors and non-survivors. At baseline, non-survivors were significantly older, were more likely to be male, and had higher APACHE II scores than survivors. More non-survivors had end-stage renal disease, chronic respiratory disease and heart failure. Within the first 24 h, hospital non-survivors were more likely to have received inotropes or vasopressors, dialysis, central venous catheterization, and acetylsalicylic acid or clopidogrel than survivors (p-values < 0.05) (Table 1).Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, 501-25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. lig28@mcmaster.ca.

ABSTRACT

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 .

No MeSH data available.


Related in: MedlinePlus