Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia

Elena Laserna, Oriol Sibila, Patrick R. Aguilar, Eric M. Mortensen, Antonio Anzueto, Jose M. Blanquer, Francisco Sanz, Jordi Rello, Pedro J. Marcos, Maria I. Velez, Nivin Aziz, Marcos I. Restrepo

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal PaCO2 (35-45 mm Hg), 194 patients (42%) had a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a PaCO 2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.

Original languageEnglish (US)
Pages (from-to)1193-1199
Number of pages7
JournalChest
Volume142
Issue number5
DOIs
StatePublished - Nov 2012

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Hypocapnia
Hypercapnia
Pneumonia
Mortality
Blood Gas Analysis
Chronic Obstructive Pulmonary Disease
Multivariate Analysis
Tertiary Care Centers
Teaching Hospitals
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia. / Laserna, Elena; Sibila, Oriol; Aguilar, Patrick R.; Mortensen, Eric M.; Anzueto, Antonio; Blanquer, Jose M.; Sanz, Francisco; Rello, Jordi; Marcos, Pedro J.; Velez, Maria I.; Aziz, Nivin; Restrepo, Marcos I.

In: Chest, Vol. 142, No. 5, 11.2012, p. 1193-1199.

Research output: Contribution to journalArticle

Laserna, E, Sibila, O, Aguilar, PR, Mortensen, EM, Anzueto, A, Blanquer, JM, Sanz, F, Rello, J, Marcos, PJ, Velez, MI, Aziz, N & Restrepo, MI 2012, 'Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia', Chest, vol. 142, no. 5, pp. 1193-1199. https://doi.org/10.1378/chest.12-0576
Laserna, Elena ; Sibila, Oriol ; Aguilar, Patrick R. ; Mortensen, Eric M. ; Anzueto, Antonio ; Blanquer, Jose M. ; Sanz, Francisco ; Rello, Jordi ; Marcos, Pedro J. ; Velez, Maria I. ; Aziz, Nivin ; Restrepo, Marcos I. / Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia. In: Chest. 2012 ; Vol. 142, No. 5. pp. 1193-1199.
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title = "Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia",
abstract = "Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41{\%}) had normal PaCO2 (35-45 mm Hg), 194 patients (42{\%}) had a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15{\%}) had a PaCO 2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95{\%} CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95{\%} CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95{\%} CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95{\%} CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.",
author = "Elena Laserna and Oriol Sibila and Aguilar, {Patrick R.} and Mortensen, {Eric M.} and Antonio Anzueto and Blanquer, {Jose M.} and Francisco Sanz and Jordi Rello and Marcos, {Pedro J.} and Velez, {Maria I.} and Nivin Aziz and Restrepo, {Marcos I.}",
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T1 - Hypocapnia and hypercapnia are predictors for ICU admission and mortality in hospitalized patients with community-acquired pneumonia

AU - Laserna, Elena

AU - Sibila, Oriol

AU - Aguilar, Patrick R.

AU - Mortensen, Eric M.

AU - Anzueto, Antonio

AU - Blanquer, Jose M.

AU - Sanz, Francisco

AU - Rello, Jordi

AU - Marcos, Pedro J.

AU - Velez, Maria I.

AU - Aziz, Nivin

AU - Restrepo, Marcos I.

PY - 2012/11

Y1 - 2012/11

N2 - Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal PaCO2 (35-45 mm Hg), 194 patients (42%) had a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a PaCO 2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.

AB - Objective: The purpose of our study was to examine in patients hospitalized with community-acquired pneumonia (CAP) the association between abnormal PaCO2 and ICU admission and 30-day mortality. Methods: A retrospective cohort study was conducted at two tertiary teaching hospitals. Eligible subjects were admitted with a diagnosis of CAP. Arterial blood gas analyses were obtained with measurement of PaCO2 on admission. Multivariate analyses were performed using 30-day mortality and ICU admission as the dependent measures. Results: Data were abstracted on 453 subjects with a documented arterial blood gas analysis. One hundred eighty-nine patients (41%) had normal PaCO2 (35-45 mm Hg), 194 patients (42%) had a PaCO 2 < 35 mm Hg (hypocapnic), and 70 patients (15%) had a PaCO 2 > 45 mm Hg (hypercapnic). In the multivariate analysis, after adjusting for severity of illness, hypocapnic patients had greater 30-day mortality (OR = 2.84; 95% CI, 1.28-6.30) and a higher need for ICU admission (OR = 2.88; 95% CI, 1.68-4.95) compared with patients with normal PaCO2. In addition, hypercapnic patients had a greater 30-day mortality (OR = 3.38; 95% CI, 1.38-8.30) and a higher need for ICU admission (OR = 5.35; 95% CI, 2.80-10.23). When patients with COPD were excluded from the analysis, the differences persisted between groups. Conclusion: In hospitalized patients with CAP, both hypocapnia and hypercapnia were associated with an increased need for ICU admission and higher 30-day mortality. These findings persisted after excluding patients with CAP and with COPD. Therefore, PaCO2 should be considered for inclusion in future severity stratification criteria to appropriate identified patients who will require a higher level of care and are at risk for increased mortality.

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