Incidence of Clinical Failure
From a total of 500 consecutive patients with CAP who were enrolled during the study period, 67 patients (13%) met at least one of the three criteria for clinical failure. The clinical failure criteria for acute pulmonary deterioration were fulfilled in 39 patients (8%), those for acute hemodynamic deterioration were fulfilled in 10 patients (2%), and those for in-hospital death were fulfilled in 36 patients (7%). Some patients met more than one criterion on the day that clinical failure was diagnosed.
Etiology of Clinical Failure
A definite etiology of clinical failure was established by an agreement of the review committee in 63 of 67 patients (94%). Not enough clinical data were available for the review committee to characterize the etiology of clinical failure in four patients. Clinical failure was defined as being related to CAP in 54 of 67 patients (81%) and as being unrelated to CAP in 9 of 67 patients (13%). The rate of clinical failure related to CAP in the study population was 11% (54 of 500 patients). Table 1 shows the etiology of clinical failure related to CAP and unrelated to CAP. Among the patients whose clinical failure was related to CAP, one patient had a combined etiology. Among all patients who experienced clinical failure due to severe sepsis, four experienced clinical failure due to septic shock overcome with Canadian Health&Care Mall.