Mortality and risk factors of patients followed up due to pneumonia in the intensive care unit

Year 2025, Volume: 16 Issue: 56, 175 - 182, 16.12.2025

Necati Mumcu , Buket Balcı Sandıkçı , Fatma Cevahir

https://doi.org/10.17944/interdiscip.1657210

Abstract

Objective: The aim of this study is to evaluate the mortality rates and mortality risk factors of patients with pneumonia in the intensive care units (ICUs).
Method: Adult patients hospitalized in ICUs with diagnoses of hospital-acquired pneumonia, ventilator-associated pneumonia, and healthcare-associated pneumonia were retrospectively evaluated. Patients were divided into two groups as those who died and those who did not die.
Results: One hundred and three patients were included in the study, 56 (54.4%) patients died. In patients who died, qSOFA (2 vs. 1, p=0.001), CURB65 (3 vs. 2, p=0.001) and NEWS (11 vs. 8, p=0.001) scores, invasive mechanical ventilation (IMV) use rate (58.9% vs. 8.5%, p=0.001), non-antipseudomonal beta-lactam antibiotic use rate (23.2% vs. 6.4%, p=0.019) and ICUs stay (10 vs. 7, p=0.027) were higher than those who did not die. In surviving patients, non-invasive mechanical ventilator use rate (38.3% vs. 17.9%, p=0.020), quinolone use rate (17% vs. 3.6%, p=0.041), duration of antibiotic use (7 days vs. 5 days, p=0.002) and first empirical treatment success rate (76.6% vs. 12.5%, p=0.001) were found to be higher. In multivariate analysis, longer stay in ICUs (p=0.019, OR=0.94, 95% CI=0.89-0.99) and use of IMV (p=0.001, OR=19.40, 95% CI=3.97-94.72) were independent risk factors for mortality. Successful initial empirical antibiotic treatment was a condition that reduced mortality (p=0.001, OR=0.038, 95% CI=0.01-0.14).
Conclusion: Avoiding IMV if possible, removing patients from ICUs as soon as possible, and initiating appropriate empirical antibiotic therapy considering the bacterial flora of each center’s ICU are important steps in reducing mortality.

Keywords

Intensive care , pneumonia , mortality

References

• Türk Toraks Derneği Erişkinlerde Hastanede Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi, 2018:1-19.
• Lakbar I, Medam S, Ronflé R, Cassir N, Delamarre L, Hammad E, et al. Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia. Sci Rep. 2021;11(1):16497. DOI:10.1038/s41598-021-95852-4.
• Candel FJ, Salavert M, Estella A, Ferrer M, Ferrer R, Gamazo JJ, et al. Ten issues to update in nosocomial or hospitalacquired pneumonia: an expert review. Journal of Clin Med. 2023;12(20):6526. DOI:10.3390/jcm12206526.
• Klevens RM, Edwards JR, Richards Jr CL, Horan TC, Gaynes RP, Pollock DA, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep. 2007;122(2):160-6. DOI:10.1177/003335490712200205.
• Türk Toraks Derneği Erişkinlerde Hastanede Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi, 2009;10(Ek6):1-24.
• Jeon ET, Lee HJ, Park TY, Jin KN, Ryu B, Lee HW, et al. Machine learning-based prediction of in-ICU mortality in pneumonia patients. Sci Rep. 2023;13(1):11527. DOI:0.1038/s41598-023-38765-8.
• Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcareassociated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388-416. DOI:10.1164/rccm.200405-644ST
• Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801-10. DOI:10.1001/jama.2016.0287
• Mattila JT, Fine MJ, Limper AH, Murray PR, Chen BB, Lin PL. Pneumonia. Treatment and diagnosis. Ann Am Thorac Socy. 2014;11(Supplement 4):S189-S92. DOI:10.1513/AnnalsATS.201401-027PL.
• Li G, Cook DJ, Thabane L, Friedrich JO, Crozier TM, Muscedere J, et al. Risk factors for mortality in patients admitted to intensive care units with pneumonia. Respir Res. 2016;17(1):80. DOI:10.1186/s12931-016-0397-5.
• Oznur E, Guzeldag S, Cakir N. Evaluating causative agents, mortality factors, and laboratory data of hospitalacquired pneumonia patients. Rev Assoc Med Bras (1992). 2021;67(12):1846-51. DOI:10.1590/1806-9282.20210764.
• Alakaya M, Arslanköylü AE. İnvaziv ve Non İnvaziv Mekanik Ventilasyon Komplikasyonları. Turkiye Klinikleri Pediatric Intensive Care-Special Topics. 2020;1(1):77-82.
• Coppadoro A, Bellani G, Foti G. Non-Pharmacological Interventions to Prevent Ventilator-Associated Pneumonia: A Literature Review. Respir Care. 2019;64(12):1586-95. DOI:10.4187/respcare.07127.
• Criner GJ, Gayen S, Zantah M, Dominguez Castillo E, Naranjo M, Lashari B, et al. Clinical review of noninvasive ventilation. Eur Respir J. 2024;7;64(5):2400396. DOI: 10.1183/13993003.00396-2024.
• Johnson CS, Frei CR, Metersky ML, Anzueto AR, Mortensen EM. Non-invasive mechanical ventilation and mortality in elderly immunocompromised patients hospitalized with pneumonia: a retrospective cohort study. BMC Pulm Med. 2014;27:14:7. DOI: 10.1186/1471-2466-14-7.0.1186/1471-2466-14-7.
• Valley TS, Walkey AJ, Lindenauer PK, Wiener RS, Cooke CR. Association Between Noninvasive Ventilation and Mortality Among Older Patients With Pneumonia. Crit Care Med. 2017;45(3):e246-e254. DOI: 10.1097/CCM.0000000000002076.
• But A, Yetkin MA, Kanyilmaz D, Aslaner H, Baştuğ A, Aypak A, et al. Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients. Turk J Med Sci. 2017;12:47(3):812-816. DOI: 10.3906/sag-1601-38.
• 18. Chittawatanarat K, Jaipakdee W, Chotirosniramit N, Chandacham K, Jirapongcharoenlap T. Microbiology, resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a Northern Thai tertiary-care university based general surgical intensive care unit. Infect Drug Resist. 2014;16(7):203-10. DOI: 10.2147/IDR.S67267.
• Öncül O. Hastane Kaynaklı Bakteriyel Enfeksiyonlar. In: Topçu AW, Söyletir G, Doğanay M, editors. Enfeksiyon Hastalıkları ve Mikrobiyolojisi. 4 ed. İstanbul: Nobel Tıp Kitap Evleri; 2017. pp. 576-613.
• Grap MJ, Munro CL, Elswick Jr R, Sessler CN, Ward KR. Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart&Lung. 2004;33(2):83-91. DOI:10.1016/j.hrtlng.2003.12.004.
• Khilnani GC, Zirpe K, Hadda V, Mehta Y, Madan K, Kulkarni A, et al. Guidelines for Antibiotic Prescription in Intensive Care Unit. Indian J Crit Care Med. 2019;23(Suppl 1):S1-s63. DOI:10.5005/jp-journals-10071-23101.
• Meshram A, Kalantri S, Tiple N. Ventilator Associated Pneumoniaina Medical Intensive Care Unit: Incidence, Risk factors and Mortality. Indian J Crit Care Med. 2025;29(Suppl1):S42–8. DOI: 10.5005/jaypeejournals-10071-24933.31.
• Falcone M, Venditti M, Shindo Y, Kollef MH. Healthcareassociated pneumonia: diagnostic criteria and distinction from community-acquired pneumonia. Int J Infect Dis. 2011;15(8):e545-e50. DOI:10.1016/j.ijid.2011.04.005.
• Polverino E, Torres A, Menendez R, Cillóniz C, Valles JM, Capelastegui A, et al. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax. 2013;68(11):1007-14. DOI:10.1136/thoraxjnl-2013-203828
• Parker CM, Kutsogiannis J, Muscedere J, Cook D, Dodek P, Day AG, et al; Canadian Critical Care Trials Group. Ventilator-associated pneumonia caused by multidrugresistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes. J Crit Care. 2008;23(1):18-26. DOI: 10.1016/j.jcrc.2008.02.001.
• Kerimoglu E, Catak T, Kilinc A. Evaluation of Infections Caused by Carbapenem-Resistant Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in an Intensive Care Unit: A Retrospective Study. Antibiotics (Basel). 2025;12;14(7):700. DOI:10.3390/antibiotics14070700.
• Hamidi AA, Kescioglu S. Identification of Factors Affecting Mortality in Late-Onset Ventilator-Associated Pneumonia. Eurasian J Med. 2020;52(3):254-258. DOI: 10.5152/eurasianjmed.2020.20005.
• Scholte JB, Duong HL, Linssen C, Van Dessel H, Bergmans D, van der Horst R, et al. Empirical antibiotic therapy for pneumonia in intensive care units: a multicentre, retrospective analysis of potentially pathogenic microorganisms identified by endotracheal aspirates cultures. Eur J Clin Microbiol Infect Dis. 2015;34(11):2295-305. DOI:10.1007/s10096-015-2482-y
• Iregui M, Ward S, Sherman G, Fraser VJ, Kollef MH. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest. 2002;122(1):262-8. DOI: 10.1378/chest.122.1.262.
• Luna CM, Aruj P, Niederman MS, Garzón J, Violi D, Prignoni A, et al. Grupo Argentino de Estudio de la Neumonía Asociada al Respirador group. Appropriateness and delay to initiate therapy in ventilator-associated pneumonia. Eur Respir J. 2006;27(1):158-64. DOI:10.1183/09031936.06.00049105.
• Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, et al. Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit. Am J Respir Crit Care Med. 2017;195(7):906-11. DOI:10.1164/rccm.201604-0854OC
• Cilloniz C, Ward L, Mogensen ML, Pericàs JM, Méndez R, Gabarrús A, et al. Machine-Learning Model for Mortality Prediction in Patients With Community-Acquired Pneumonia: Development and Validation Study. Chest. 2023;163(1):77-88. DOI:10.1016/j.chest.2022.07.005