Factores pronósticos, evolución y mortalidad en el adulto inmunocompetente hospitalizado por neumonía neumocócica adquirida en la comunidad
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Fernando Saldías P [1] ; Paola Viviani G [1] ; Dahiana Pulgar B [1] ; Francisco Valenzuela F [1] ; Sebastián Paredes E [1] ; Orlando Díaz P [1]
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[1] Pontificia Universidad Católica de Chile
Pontificia Universidad Católica de Chile
Santiago, Chile
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- Localización: Revista Médica de Chile, ISSN-e 0034-9887, Vol. 137, Nº. 12, 2009, págs. 1545-1552
- Idioma: español
- Títulos paralelos:
- Prognostic factors and mortality in immunocompetent adult patients hospitalized with community-acquired pneumococcal pneumonia
- Enlaces
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Resumen
Background: Streptococcus pneumoniae is the main cause of community-acquired pneumonia in adults. Aim: To describe baseline characteristics, risk factors and clinical outcomes of adult patients hospitalized with pneumococcal pneumonia. Material and methods: Prospective study of adult patients admitted for a community acquired pneumonia in a clinical hospital. Immune deficient patients and those with a history of a recent hospitalization were excluded. Results: One hundred fifty one immuno-competent patients, aged 16 to 92 years, 58% males, were studied. Seventy-five percent had other diseases, 26% were admitted to the intensive care unit and 9% needed mechanical ventilation. There were no differences in clinical features, ICU admission or hospital length of stay among bacteremic and non-bacteremic patients. Thirty days lethality for bacteremic and non-bacteremic patients was 10.9% and 11.5%, respectively. The predictive values for lethality of Fine pneumonia severity index and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older) had an area under the ROC curve of 0.8 and 0.69, respectively. Multivariate analysis disclosed blood urea nitrogen over 30 mg/ dL (odds ratio (OR), 6.8), need for mechanical ventilation (OR, 7.4) and diastolic blood pressure below 50 mmHg (OR, 3.9), as significant independent predictors of death. Conclusions: Pneumococcal pneumonia was associated with a substantial rate of complications and mortality. Clinical presentation and outcome did not differ significantly among patients with and without bacteremia.
