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Jean-Yves Fagon, MD; Jean Chastre, MD; Albert Vuagnat, MD; Jean-Louis Trouillet, MD; Ana Novara, MD; Claude Gibert, MD

JAMA. 1996;275(11):866-869.

Abstract
Objective.
—To evaluate the role that nosocomial pneumonia plays in the outcome of intensive care unit (ICU) patients.

Design.
—Cohort study.

Setting.
—Medical ICU, Hôpital Bichat, Paris, France, an academic tertiary care center.

Patients.
—A total of 1978 consecutive patients admitted to the ICU for at least 48 hours.

Main Outcome Measures.
—Various parameters known to be strongly associated with death of ICU patients were recorded: age, location before admission to the ICU, diagnostic categories, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiologic Score, McCabe score, number and type of dysfunctional organs, and the development of nosocomial bacteremia and nosocomial urinary tract infection. These variables and the presence or absence of nosocomial pneumonia were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles.

Results.
—Nosocomial pneumonia developed in 328 patients (16.6%) whose mortality rate was 52.4% compared with 22.4% for patients without ICU-acquired pneumonia (P<.001). APACHE II score (odds ratio [OR]=1.08; 95% confidence interval [CI], 1.06 to 1.10; P<.001), number of dysfunctional organs (OR=1.54; 95% CI, 1.36 to 1.74; P<.001), nosocomial pneumonia (OR=2.08; 95% CI, 1.55 to 2.80; P<.001), nosocomial bacteremia (OR=2.51; 95% CI, 1.78 to 3.55; P<.001), ultimately or rapidly fatal underlying disease (OR=1.76; 95% CI, 1.38 to 2.25; P<.001), and admission from another ICU (OR=1.30; 95% CI, 1.01 to 1.68; P=.04) were significantly associated with mortality.

Conclusion.
—These data suggest that, in addition to the severity of underlying medical conditions and nosocomial bacteremia, nosocomial pneumonia independently contributes to ICU patient mortality.

(JAMA. 1996;275:866-869)

Author Affiliations
From the Service de Réanimation Médicale, Hôpital Bichat, Paris, France. Drs Fagon and Novara are now with Service de Réanimation Médicale, Hôpital Broussais, Paris, France.

Footnotes
Presented in part at the 1993 American Lung Association/American Thoracic Society International Conference, San Francisco, Calif, May 18, 1993.

Reprint requests to Service de Réanimation Médicale Hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France (Dr Fagon).

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, Ill; Joseph E. Parrillo, MD, Chicago, Ill; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

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