Clinical profile and outcomes of patients with community-acquired pneumonia in Brazilian public intensive care units

Autores: Rodolfo Eduardo de Andrade Espinoza1, Flávio Elias Callil2, Robson Correa Santos3, Ulisses de Oliveira Melo4, Anke Bergmann1, Jorge Ibrain Figueira Salluh5
1Instituto Nacional do Câncer – Rio de Janeiro (RJ), Brasil; 2Hospital Estadual Getúlio Vargas – Rio de Janeiro (RJ), Brasil; 3Hospital Estadual Adão Pereira Nunes – Rio de Janeiro (RJ), Brasil; 4Hospital Estadual Alberto Torres – Rio de Janeiro (RJ), Brasil; 5Instituto D’Or de Pesquisa e Educação – Rio de Janeiro (RJ), Brasil

Objective: Describe characteristics and outcomes of community-acquired pneumonia (CAP) admitted to public
ICUs in Brazil.

Methods: Retrospective cohort study in 4 Tertiary Public Hospitals in Rio de Janeiro, Brazil during 2016. Patients admitted to ICUs with a diagnosis of community-acquired pneumonia were included. Clinical and outcomes data were collected from Epimed Monitor System.

Results: From 7902 admissions, 802 patients (10,1%) were included and analyzed. Main source of admission was the emergency department (78,3%). Median age was 66 (54- 77) years, SAPS3 71(58-83) and SOFA D1 9(5-12) points. 67% of patients needed invasive mechanical ventilation, 12% hemodialysis. 47% required vasopressors. ICU and hospital mortality were 55.9% and 66.5% respectively. In a multivariate analysis, malnutrition [ OR 2.28(1.21-
4.3)], septic shock at admission [OR 1.95(1.39-2.75)], AIDS [3.04(1.16-7.93]), invasive mechanical ventilation
[5.07(5.54-7.27)], age > 65 years [2.07(1.48-2.90)] and LOS >1 day before ICU admission [1.90(1.34-2.71)] were
associated with increased mortality.

Conclusion: CAP is associated with high mortality in patients admitted to public ICUs in Brazil. The current
findings may help improve resource allocation and should aim at improving access to ICU care since delayed admission was associated with increased hospital mortality.