Predictors of Combes et al for Recurrent Pneumonia or Death for a Patient with Ventilator-Associated Pneumonia (VAP)

 

Parameters:

(1) age

(2) gender

(3) disease severity (based on McCabe, SAPS II and/or SOFA scores)

(4) organism causing the VAP

(5) duration of dependency on mechanical ventilation (MV)

(6) fever (>= 38°C)

(7) degree of lung injury (based on the radiologic score on days 1, 3 and 8)

 

Parameter	Finding	Points
age	younger	0
	older	1
gender	male	0
	female	1
disease severity	lower SOFA score	0
	higher SOFA score	1
causative organisms	nonfermenting Gram-negative bacteria OR methicillin resistant Staphylococcus aureus (MRSA)	1
	other	0
dependency on MV	not prolonged	0
	prolonged	1
fever	short-term	0
	persistent	1
degree of lung injury	none to moderate	0
	severe	1

 

where:

• Survivors had an age range of 59 +/- 17 while those who died had an age range of 70 +/- 12. An age >= 70 will be used as cutoff for increased risk.

• The PNEUMA trial was a multicenter, randomized comparison of antibiotic treatment for culture-proven VAP using appropriate antibiotics for 8 vs 15 days.

• The admission SOFA scores in patients without VAP recurrence was 7.0 +/- 3.9 vs 8.5 +/- 4.0 for those with VAP recurrence. A SOFA >= 10 will be used to indicate increased risk for complications.

• Both MRSA and nonfermenting Gram-negative bacteria involve antibiotic resistance.

 

total number of risk factors =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 7

• The risk of recurrent pneumonia or death increased with the number of risk factors.

• The mortality at 60 days after VAP onset was 34% with recurrent VAP vs 24% withour recurrence.