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Thirty consecutively intubated patients with pneumonia due to Pseudomonas aeruginosa (cases) were prospectively observed to establish the attributable mortality rate and the prognostic value of APACHE (Acute Physiological and Chronic Health Evaluation) II scores. Four cases did not receive accurate empirical therapy and were excluded from the study. APACHE II scores were calculated within 24 hours of admission (T0), at the time of the diagnosis of pneumonia (T1), and after 72 hours of therapy (T2). The outcomes for these cases (n = 26) were compared with those for matched controls (n = 52) without pneumonia. Six cases died of causes directly related to pneumonia (group D). Two cases whose conditions clinically improved died of cardiac complications, and 18 cases had clinical resolution (group R); however, only 15 of these cases were alive at discharge. The mean APACHE II score at admission was similar (P > .20) for group R, group D, and controls. In contrast, the mean score at T1 (15.40 +/- 6.07 vs. 20.83 +/- 4.66; P < .05) and the mean score at T2 (10.40 +/- 3.57 vs. 25.50 +/- 3.93; P < .01) differed significantly for groups R and D, respectively. The overall observed and predicted mortality rates among cases and controls were 42.3% and 28.1% and 28.8% and 28.7%, respectively, while the attributable mortality rate among cases was estimated to be 13.5% (95% confidence interval, 1.95%-25.04%). We conclude that the attributable mortality rate among intubated patients with pneumonia due to P. aeruginosa is high. The APACHE II score at admission is not useful as a prognostic factor, while progression of organ dysfunction after the onset of pneumonia is an ominous sign.
Rello et al. (Fri,) studied this question.