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ULTIMO FASCICOLOMINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2013 Dicembre;79(12):1356-65

 ORIGINAL ARTICLES

Clinical characteristics and prognosis of pneumonia and sepsis: multicenter study

Kim W.-Y. 1, Lee Y.-J. 2, Yeon Lim S. 3, Ok Koh S. 4, Choi W.-I. 5, Chan Kim S. 6, Rak Chon G. 7, Hyeong Kim J. 8, Yeol Kim J. 9, Lim J. 10, Kook Rhee C. 6, Park S. 11, Cheol Kim H. 12, Hwa Lee J. 13, Hyun Lee J. 14, Park J. 15, Koh Y. 1, Young Suh G. 3, Hong S.-B. 1

1 Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;
2 Department of Anesthesiology, Ajou University College of Medicine, Suwon, Gyeonggi-do, Republic of Korea;
3 Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;
4 Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea;
5 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Keimyung University, Dongsan Hospital, Daegu, Gyeongsangbuk-do, Republic of Korea;
6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary’s Hospital, Catholic University of Korea, Seoul, Republic of Korea;
7 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chungju Hospital, School of Medicine of Konkuk University, Chungju, Chungcheongbuk-do, Republic of Korea;
8 Sleep and Critical Care Medicine, Department of Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea;
9 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea;
10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan Medical College of Internal Medicine, Gangneung, Gangwon-do, Republic of Korea;
11 Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Republic of Korea;
12 Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Gyeongsangnam-do, Republic of Korea;
13 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea;
14 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bundang CHA Hospital CHA University, Bundang, Gyeonggi-do, Republic of Korea;
15 Department of Multimedia, Seoul Women’s University, Seoul, Republic of Korea

Background: Pneumonia is the primary source of sepsis and is significantly associated with mortality. However, only a few studies focus on its clinical characteristics and outcomes.
Methods: We evaluated 500 intensive care unit patients who met severe sepsis or septic shock criteria, dividing them into two distinct groups (43%, sepsis with pneumonia; 41%, sepsis with an infection other than pneumonia).
Results: Moderate differences between the groups were observed. The group of sepsis with pneumonia had a higher 28-day in-hospital mortality (41% vs. 30%; P=0.02). Multivariate analysis revealed that the presence of pneumonia associated significantly with mortality (OR 1.76, 95% CI 1.11-2.78) along with cardiopulmonary resuscitation (OR 4.20, 95% CI 1.50-11.74), serum lactate ≥3.5 mmol/L (OR 1.92, 95% CI 1.20-3.08), and SOFA score ≥12 (OR 2.41, 95% CI 1.52-3.82). Survival analysis revealed for both groups that the patients with PaO2/FiO2 (PF) ratio <170 and lactate ≥3.5 mmol/L had a worse prognosis than the patients with PF ratio ≥170 and lactate ≥3.5 mmol/L or PF ratio <170 and lactate <3.5 mmol/L.
Conclusion: In patients admitted with sepsis, the pneumonia infection independently predicts 28-day in-hospital mortality. Combining the levels of serum lactate and PF ratio could be a useful approach in predicting mortality of these patients.

lingua: Inglese


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