TY - JOUR
T1 - Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia
AU - Laserna, Elena
AU - Sibila, Oriol
AU - Aguilar, Patrick R.
AU - Mortensen, Eric M.
AU - Anzueto, Antonio
AU - Blanquer, Jose M.
AU - Sanz, Francisco
AU - Rello, Jordi
AU - Marcos, Pedro J.
AU - Velez, Maria I.
AU - Aziz, Nivin
AU - Restrepo, Marcos
N1 - Funding Information:
Funding/Support: This research was supported by a Howard Hughes Medical Institute faculty start-up grant [00378-001] and a Department of Veteran Affairs Veterans Integrated Service Network 17 new faculty grant. Drs Laserna and Sibila are supported by Sociedad Espanola de Neumologia y Cirugia Toracica, Societat Catalana de Pneumologia, and Fundacio Catalana de Pneumologia. Dr Sibila is supported by Instituto de Salud Carlos III [Grant BAE11/00102]. Dr Restrepo's time is partially protected by an award from the National Heart, Lung, and Blood Institute [K23HL096054].
PY - 2012/11
Y1 - 2012/11
N2 - Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 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 a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a PaCO 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.
AB - Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 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 a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a PaCO 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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U2 - 10.1378/chest.12-0576
DO - 10.1378/chest.12-0576
M3 - Article
C2 - 22677348
AN - SCOPUS:84868623136
SN - 0012-3692
VL - 142
SP - 1193
EP - 1199
JO - Chest
JF - Chest
IS - 5
ER -