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Multicenter Study
. 2012 Nov;142(5):1193-1199.
doi: 10.1378/chest.12-0576.

Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia

Elena Laserna  1 , Oriol Sibila  2 , Patrick R Aguilar  3 , Eric M Mortensen  4 , Antonio Anzueto  5 , Jose M Blanquer  6 , Francisco Sanz  7 , Jordi Rello  8 , Pedro J Marcos  9 , Maria I Velez  5 , Nivin Aziz  3 , Marcos I Restrepo  10
Affiliations
Multicenter Study

Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia

Elena Laserna et al. Chest. 2012 Nov.

Abstract

Objective: The purpose of our study was to examine in patients hospitalized with community acquired pneumonia (CAP) the association between abnormal Pa CO 2 and ICU admission and 30-day mortality.

Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures.

Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal PaCO2 (35-45 mm Hg), 194 patients (42%) had aPa CO 2 , 35 mm Hg (hypocapnic), and 70 patients (15%) had a Pa CO 2 . 45 mm Hg (hypercapnic).In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR= 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR= 2.88;95% CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR= 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission(OR =5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis,the differences persisted between groups.

Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.

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Figures

Figure 1.
Figure 1.
Cox survival curves of patients with hypocapnia (Paco2 < 35 mm Hg) and hypercapnia (Paco2 > 45 mm Hg) vs those with normocapnia (Paco2 35-45 mm Hg) at admission. Cum = cumulative.
See this image and copyright information in PMC

References

    1. Kozak LJ, DeFrances CJ, Hall MJ. National hospital discharge survey: 2004 annual summary with detailed diagnosis and procedure data. Vital Health Stat 13. 2006;162(162):1-209 - PubMed
    1. Trotter CL, Stuart JM, George R, Miller E. Increasing hospital admissions for pneumonia, England. Emerg Infect Dis. 2008;14(5):727-733 - PMC - PubMed
    1. Renaud B, Santin A, Coma E, et al. Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Crit Care Med. 2009;37(11):2867-2874 - PubMed
    1. Ewig S, Woodhead M, Torres A. Towards a sensible comprehension of severe community-acquired pneumonia. Intensive Care Med. 2011;37(2):214-223 - PubMed
    1. Restrepo MI, Anzueto A. Severe community-acquired pneumonia. Infect Dis Clin North Am. 2009;23(3):503-520 - PubMed

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