Severe community-acquired pneumonia requiring intensive care: a study of 80 cases from Singapore

Poulose V
Correspondence: Dr Vijo Poulose, vijo_poulose@cgh.com.sg

ABSTRACT
Introduction Severe community-acquired pneumonia is a major cause of mortality and morbidity worldwide. This study looked at the clinical characteristics of these patients admitted to a Singaporean community hospital and the prognostic impact of age, bacteraemia and logistic organ dysfunction score (LODS) on intensive care unit mortality.
Methods Retrospective analysis of 80 severe community-acquired pneumonia patients admitted to the intensive care unit over a 20-month period was conducted. The Mann-Whitney U and chi-square tests were used for statistical analysis and a p-value of less than 0.5 was considered as significant.
Results There were 55 male and 25 female patients, with a median age of 62 years. The median LODS was 5. The intensive care unit mortality was 30 percent. The median LODS of intensive care unit survivors was 5 and of non-survivors, 8. The overall hospital mortality was 37.5 percent. A microbiological aetiology was identified in 38 percent of patients. Three of four patients with melioidosis died. Between intensive care unit survivors and non-survivors, there was a significant difference in the LODS, but no significant difference in the age and incidence of bacteraemia.
Conclusion Severe community-acquired pneumonia is a highly fatal disease which requires early initiation of appropriate empirical antibiotic therapy, which should include coverage for melioidosis in the local context. The microbiological workup should include testing for tuberculosis. The LODS system may be an appropriate tool in estimating the severity of illness.

Keywords: intensive care unit, logistic organ dysfunction score, melioidosis, severe community-acquired pneumonia
Singapore Med J 2008; 49(6):458-461