Outcomes of patients admitted to the intensive care unit with community-acquired pneumonia in a tertiary care center in Riyadh, Saudi Arabia

Talal Oreibi; Farhan Alenezi; Amjad M Ahmed; Felwa Bin Humaid; Musharaf Sadat; Hani Mohammed Tamim; Faisal Fouad Baseet; Brintha Naidu; Yaseen M Arabi

doi:10.4103/atm.atm_49_23

Outcomes of patients admitted to the intensive care unit with community-acquired pneumonia in a tertiary care center in Riyadh, Saudi Arabia

Ann Thorac Med. 2023 Oct-Dec;18(4):206-210. doi: 10.4103/atm.atm_49_23. Epub 2023 Oct 17.

Authors

Talal Oreibi^{1

2}, Farhan Alenezi^{1

2}, Amjad M Ahmed^{1

2}, Felwa Bin Humaid¹, Musharaf Sadat^{1

2}, Hani Mohammed Tamim^{2

3

4}, Faisal Fouad Baseet^{1

2}, Brintha Naidu^{1

2}, Yaseen M Arabi^{1

2}

Affiliations

¹ King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
² King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
³ American University of Beirut-Medical Center, Beirut, Lebanon.
⁴ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Abstract

Background: Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) morbidity and mortality. Despite extensive international epidemiological and clinical studies to improve those patients' outcomes, local statistics in Saudi Arabia are limited. The objective of this study is to describe the clinical characteristics and outcomes of patients admitted to the ICU with the diagnosis of CAP reflecting the experience of a tertiary center over an 18-year period.

Methods: A retrospective cohort study included all consecutive adult ICU patients diagnosed with CAP between 1999 and 2017. Baseline demographics, patients' risk factors, and initial admission laboratory investigations were compared between survivors and nonsurvivors. A multivariate regression model was used to predict mortality.

Results: During the study period, there were 3438 patients admitted to the ICU with CAP (median age 67 [Quartile 1, 3 (Q1, Q3) 51, 76] years) and 54.4% were males, of whom 1007 (29.2%) died. The survivors compared with nonsurvivors were younger (65 vs. 70 years), less likely to have chronic liver disease (2.4% vs. 10.5%), chronic renal failure (8.1% vs. 14.4%), and be immunocompromised (10.2% vs. 18.2%), and less frequently required mechanical ventilation or vasopressors (46.2% vs. 80.5% and 29.6% vs. 55.9%, respectively). Acute Physiology and Chronic Health Evaluation (APACHE) II score was significantly higher among nonsurvivors (median score 26 vs. 20) with a longer duration of mechanical ventilation and ICU stay. Using a multivariate regression model, age, APACHE II score, bilirubin level, vasopressors, and mechanical ventilation were significantly associated with increased mortality, while diabetes was associated with lower mortality.

Conclusion: Around one-third of patients admitted to the ICU with CAP died. Mortality was significantly associated with age, APACHE II score, vasopressor use, and mechanical ventilation. A comprehensive national registry is needed to enhance epidemiological data and to guide initiatives for improving CAP patients' outcomes.

Keywords: Community-acquired pneumonia; critical care; hospital mortality; retrospective.