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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3072 — Late Admission to the ICU in Patients with Community-Acquired Pneumonia is Associated with Higher Mortality

Restrepo MI (VERDICT) , Mortensen EM (VERDICT), Anzueto A (STVHCS)

Community-acquired pneumonia (CAP) is the leading infectious cause of death in the United States. Limited data are available on patients’ outcomes based on time of ICU admission. Our objective was to compare the 30-day mortality in CAP patients that have early ICU admission (EICUA - direct admission or within 24 hours) versus late ICU admission (LICUA - >2 days).

A retrospective cohort study was conducted at two tertiary teaching hospitals. Data were abstracted on 161 eligible subjects that were admitted to the ICU with a diagnosis of CAP (by ICD-9 codes) between 1/1999 and 12/2001 and radiologic confirmation of CAP. Subjects were excluded if they were “comfort measures only” or transferred from another acute care hospital. Patients were stratified based on the time of ICU admission as EICUA and LICUA. The ATS severity criteria were used for risk adjustment. A Cox proportional hazard model was created with mortality as the dependent measure, and the ATS severity criteria and the stratified time to ICU admission as the independent measures.

One hundred and forty four (88%) of the patients had an EICUA compared to 19 (12%) LICUA. Groups were similar with respect to age, gender, comorbidities, clinical parameters, CAP-related process of care measures, need for mechanical ventilation, and need for vasopressors. LICUA patients had lower rates of ATS severity criteria at presentation (26.3% vs. 53.5%; p=0.3). LICUA patients (47.4%) had a higher 30-day mortality (hazard ratio (HR), 95% confidence interval (CI)) when compared to EICUA (23.2%) (HR=3.0, 1.11-7.93) and longer LOS in days (SD) (17.3 (13.5) vs. 11.9 (10.4); p=0.04). In the Cox proportional hazard model, after adjusting for severity of illness, a late admission to the ICU was associated with higher 30-day mortality (HR=2.6, 95% CI 1.2-5.5).

CAP patients with a late admission to the ICU have an increased 30-day mortality after adjustment for severity of illness.

Additional research is needed to examine ways to improve clinical outcomes for patients who have late admission to the ICU.

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