Outcomes of Early, Late, and No Admission to the Intensive Care Unit for Patients Hospitalized with Community-acquired Pneumonia

Renaud B et al. – This study suggests that late but not early admission to the ICU is associated with higher 28–day mortality for patients hospitalized with community–acquired pneumonia (CAP). Patients admitted to the intensive care unit (ICU) have longer hospital length of stay (LOS) in comparison to those managed on the wards, particularly if they are admitted late to the ICU.

Methods

• This was a post hoc analysis of the original data from the Emergency Department Community-Acquired Pneumonia (EDCAP) and Pneumocom-1 prospective multicenter cohort studies of adult patients hospitalized with CAP.
• Propensity score–adjusted analysis was used to compare 28-day mortality and hospital length of stay (LOS) for 199, 144, and 2,215 patients with early (i.e., ICU admission on the day of emergency department [ED] presentation), late, and no ICU admission.

Results

• Unadjusted 28-day mortality rates were 13.1, 19.4, and 5.7% for early, late, and no ICU admissions, respectively (p<0.001).
• After adjusting for quintile of propensity score, the odds of 28-day mortality were higher for late ICU admissions relative to early ICU admissions (odds ratio [OR]=2.63; 95% confidence interval [CI]=1.42 to 4.90), and no ICU admissions (OR=3.40; 95% CI=2.11 to 5.48), but did not differ between early and no ICU admissions (OR=1.29; 95% CI=0.79 to 2.09).
• The median hospital LOS was 10days for early (interquartile range [IQR]=7 to 18), 15days for late (IQR 9 to 23), and 6days (IQR 4 to 9) for no ICU admissions (p<0.001).

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