Mortality and predictors of death in patients with pneumonia admitted to the intensive care unit

Background

Community-acquired pneumonia remains a common and serious condition.

Methods

We retrospectively evaluated patients with pneumonia admitted to the medical intensive care unit (MICU) of Ewha Womans University Hospital from 1 January 2000 through 31 December 2003. We excluded patients who died within 48 hours after admission, were pretreated before admission or had pulmonary tuberculosis or suspected nosocomial pneumonia. Finally, 118 patients were included.

Results

Mortality was 41.5% (49/118). At admission, survivors had significantly higher white blood cell counts (P < 0.05), lower serum potassium levels (P < 0.05), larger first 24-hour urine output (P < 0.01), higher Glasgow coma scales (P < 0.001), and lower Acute Physiology and Chronic Health Evaluation Score (APACHE II) (P < 0.01) than non-survivors. During hospitalization, there was significantly lower incidence of gastrointestinal (GI) bleeding in survivors compared with non-survivors (P < 0.001). MICU stay (P < 0.05) and days requiring mechanical ventilation (P < 0.001) and intubation were significantly shorter in survivors compared with those in non-survivors (P < 0.01). Tracheostomy was less frequently performed in survivors compared with that in non-survivors (P < 0.01). In survival analysis using Cox regression, GI bleeding (relative risk [RR], 2.35; 95% confidence interval [CI], 1.24–4.48) and an APACHE II score of 20 or more (RR, 2.19; 95% CI, 1.21–3.96) were independently associated with death.

Conclusion

In patients with severe pneumonia, mortality was still high. GI bleeding during hospitalization as well as high APACHE II score was related to mortality.