Outlet of Incidence, Etiology, Timing, and Risk Factors for Clinical Failure in Hospitalized Patients With Community-Acquired Pneumonia

Clinical Failure

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.

Methods of Incidence, Etiology, Timing, and Risk Factors for Clinical Failure in Hospitalized Patients With Community-Acquired Pneumonia

CAP

Study Design and Study Patients

This was an observational, retrospective study of consecutive patients who were admitted with a diagnosis of CAP to the Veterans Affairs Medical Center of Louisville, KY, between June 2001 and March 2006. Patients enrolled in this study are part of the Community-Acquired Pneumonia Organization database. The study protocol and data collection form are available on the study Web site (www.caposite.com). The institutional review board of the Veterans Affairs Medical Center approved the study. Patients who were > 18 years of age and satisfied the criteria for CAP were included in this study.

The records of all enrolled patients were reviewed. Data, including demographic information, clinical data on hospital admissions, radiologic findings, and laboratory values, were collected. The severity of pneumonia was evaluated by the pneumonia severity index (PSI) and CURB-65 (confusion, urea level > 7 mmol/L respiratory rate > 30 breaths/min, systolic BP < 90 mm Hg or diastolic BP < 60 mm Hg, or age > 65 years) scores; microbiological and in-hospital treatment data; and autopsy results.