PROGNOSTIC FACTORS OF PNEUMONIA REQUIRING ADMISSION TO THE INTENSIVE-CARE UNIT

All patients with severe pneumonias (community-acquired and nosocomial ) who required treatment in the intensive care unit (ICU) were include d in a 3-year prospective study, Predictive factors for a fatal outcom e were analyzed in 127 patients, An etiologic diagnosis was made in 70 (55.1%) patients, Culture of sputum or tracheobronchial secretions we re used only as criteria for microbiologic diagnosis of Legionella pne umophila. The pathogens most frequently identified were L pneumophila, Streptococcus pneumoniae, and Pseudomonas aeruginosa, Viruses were no t detected as causative agents. A total of 54 patients died (mortality rate, 42.5%). The univariate analysis showed the following factors as sociated with mortality: advanced age (greater than or equal to 70 yea rs); presence of septic shock, requirement of mechanical ventilation, and Simplified Acute Physiology Score [SAPS] index >12 at the time of admission to the ICU or when symptoms appeared in patients already adm itted to the ICU; development of any complication during ICU hospitali zation; and P aeruginosa as the etiologic agent of the pneumonia, When all variables were introduced by a stepwise method, the final model i ncluded advanced age (greater than or equal to 70 years), SAPS index > 12, presence of septic shock, requirement of mechanical ventilation, b ilateral pulmonary involvement, and P aeruginosa as the etiologic agen t of pneumonia as prognostic factors associated with a fatal outcome,