Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study

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Objective:Describe characteristics and outcomes of CAP admitted to public ICUs in Brazil.Methods:Retrospective cohort study in 4 Tertiary Public Hospitals in Rio de Janeiro, Brazil during 2016. Patients admitted to ICUs with a diagnosis of community-acquired pneumonia were included. Clinical and outcomes data were collected from Epimed Monitor System.Results:From 7902 admissions, 802 patients (10, 1%) were included and analyzed. Main source of admission was the emergency department (78, 3%). Median age was 66 (IQR 54–77) years, SAPS3 71(IQR 58–83) and SOFA D1 9(IQR 5–12) points. 67% of patients needed invasive mechanical ventilation, 12% hemodialysis. 47% required vasopressors. ICU and hospital mortality were 55.9% and 66.5% respectively. In a multivariate analysis, malnutrition [OR 2.28(1.21–4.3)], septic shock at admission [OR 1.95(1.39–2.75)], AIDS [3.04(1.16–7.93]), invasive mechanical ventilation [5.07(5.54–7.27)], age>65years [2.07(1.48–2.90)] and LOS >1day before ICU admission [1.90(1.34–2.71)] were associated with increased mortality.Conclusion:CAP is associated with high mortality in patients admitted to public ICUs in Brazil. The current findings may help improve resource allocation and should aim at improving access to ICU care since delayed admission was associated with increased hospital mortality.HIGHLIGHTSCommunity-acquired pneumonia admitted to intensive care units is associated with high mortalityPre-existing factors as severe comorbidities and acute illness were independently associated to hospital mortalityAn organizational (days in hospital before ICU) factor had significant impact on the odds of hospital survival.

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