An early predictor of the outcome of patients with ventilator-associated pneumonia

Abstract

Background: Ventilator-associated pneumonia (VAP) contributes to high mortality, prolonged intensive care unit (ICU) stay and increased costs of health care. Reports of early predictors of death in patients with VAP are rare. Our study was designed to determine early predictors of poor outcome in patients with VAP.

Methods: A total 838 patients with nosocomial lower respiratory tract infection in a tertiary medical center from January, 2004 to June, 2006 were retrospectively reviewed. Forty-two patients had VAP and were enrolled in the study. The age, sex, underlying diseases, including hypertension, diabetes mellitus, chronic obstructive pulmonary disease, end-stage renal disease, congestive heart failure/coronary artery disease, and collagen vascular disease, diagnosis at admission, Acute Physiological Assessment and Chronic Health Evaluation II score (APACHE II score), Clinical Pulmonary Infection Score (CPIS), time between intubation and ICU admission, time between intubation and development of VAP, risk factors for multi-drug resistant pathogens, time to adequate therapy, initial antibiotics regimen, bacterial cultures, mortality rate from VAP, 28-day mortality rate and in-hospital mortality rate were compared between the mortality group and non-mortality group.

Results: The VAP, 28-day and in-hospital mortality rates were 23.8% (10/42), 40.5% (17/42) and 50% (21/42), respectively. The APACHE II score (p=0.002) and CPIS (p=0.048) at the onset of VAP, inadequate initial antibiotics treatment (p=0.007) and concomitant bacteremia (p=0.008) were the only parameters which were significantly different between groups. The independent risk factors for VAP mortality in multivariable analysis were the APACHE II score at the onset of VAP (p=0.018), inadequate initial antibiotics treatment (p=0.032) and concomitant bacteremia (p=0.034). An APACHE II score>27 at VAP onset was an independent and early predictor of the mortality. (ROC AUC: 0.841; Sensitivity: 70%; Specificity: 90.6%; p=0.001).

Conclusion: A high APACHE II score (>27) at VAP onset was an independent and early predictor of mortality due to VAP.