THE INTENSIVE-CARE MANAGEMENT, MORTALITY AND PROGNOSTIC INDICATORS INSEVERE COMMUNITY-ACQUIRED PNEUMOCOCCAL PNEUMONIA

Objective: To determine mortality and factors that might predict outco me in severe community-acquired pneumococcal pneumonia treated by a st andard protocol.Design: Prospective, non-concurrent study. Setting: Re spiratory intensive care unit (ICU) in a teaching hospital. Patients: 63 patients who were diagnosed by positive blood culture or Gram stain and culture of sputum or tracheal aspirate were included. Measurement s and results: Clinical features, severity scores including Acute Phys iology and Chronic Health Evaluation (APACHE) II, organ failure and lu ng injury scores, and the clinical course in the ICU were documented; 79% of patients required mechanical ventilation. Bacteraemia was prese nt in 34 patients (54%); there were no distinguishing clinical feature s between bacteraemic and non-bacteraemic cases. The overall mortality was 21%, with only 5 deaths (15% mortality) in the bacteraemic group. Shock and a very low serum albumin (< 26 g/l) were the only clinical features that differentiated survivors from non-survivors; lung injury , APACHE II and multiple organ failure scores were all predictive of o utcome. The positive predictive value and specificity in predicting de ath in individuals for the modified British Thoracic Society rule 1 we re 26 and 64%; APACHE II > 20 57 and 88%; > 2 organ failure 64 and 92% ; and lung injury > 2 33 and 73%, respectively. Conclusions: These res ults suggest that even in bacteraemic cases mortality should be below 25% with intensive care management and that conventional scoring syste ms, while predictive of group mortality, are unreliable in individuals .