Risk factors for mortality in mechanically ventilated patients with nosocomial pneumonia

Background

Patients who develop pneumonia while receiving mechanical ventilation appear to have a two- to tenfold increased risk of mortality compared to patients without pneumonia.

Objective

The aim of this study was to identify possible risk indicators for pneumonia leading to death in critically ill patients.

Methods

Several potential risk factors for mortality in ventilated patients with nosocomial pneumonia were evaluated using multivariate statistical techniques.

Results

Eighty-two (26%) episodes of nosocomial pneumonia were detected in 314 consecutive patients admitted to an 18-bed general intensive care unit from January to December 1995. The mortality of patients with nosocomial pneumonia was higher when compared with fatality rates of patients without pneumonia (34% versus 17.2%, P < 0.01). Multivariate analysis selected three prognostic factors significantly associated with higher risk of death: the presence of septic shock (OR 18.93, 95% CI, P < 0.01); ARDS (OR 30.64, 95% CI, P < 0.01); and APACHE II score at the time pneumonia was diagnosed (OR 1.27). Of note is that many other factors were significantly associated with mortality but were not an independent predictors of mortality.

Conclusion

In the present study, the presence of shock and ARDS were the strongest predictors for mortality in ventilated patients with nosocomial pneumonia.