Intensive Care Medicine

, Volume 15, Issue 5, pp 302–307

Community-acquired pneumonia of diverse aetiology: prognostic features in patients admitted to an intensive care unit and a “severity of illness” score

  • C. Feldman
  • J. M. Kallenbach
  • H. Levy
  • S. G. Reinach
  • M. D. Hurwitz
  • J. R. Thorburn
  • H. J. Koornhof
Original Articles


In a retrospective study of 73 patients with community-acquired lobar pneumonia of diverse aetiology admitted to an intensive care unit, an attempt was made to identify those factors among the demographic and clinical features and results of initial laboratory investigations that were predictive of the ultimate outcome. A lower mean white cell count (p=0.03), platelet count (p=0.02), total serum protein (p=0.005) and albumin (p=0.02) and a higher mean serum creatinine (p=0.03) and phosphate level (p=0.02) appeared to be predictive of a poor prognosis. The most significant variable predictive of mortality, was the presence of bacteraemia (p=0.0005). Severity of illness scoring systems by omitting microbiological data appear to underestimate predicted patient mortality. The mortality rate of critically ill patients with community-acquired lobar pneumonia remains high, despite advances in antimicrobial chemotherapy and intensive care unit facilities, particularly in the presence of certain negative prognostic factors of which the presence of bacteraemia is the most important.

Key words

Community-acquired lobar pneumonia Intensive care unit Bacteraemia 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sullivan RJ Jr, Dowdle WR, Marine WM, Hierholzer JC (1972) Adult pneumonia in a general hospital. Etiology and host risk factors. Arch Intern Med 129:935–942Google Scholar
  2. 2.
    Austrian R, Gold J (1964) Pneumococcal bacteremia with especial reference to bacteremic pneumococcal pneumonia. Ann Intern Med 60:759–776Google Scholar
  3. 3.
    Mufson MA, Chang V, Gill V, Wood SC, Romansky MJ, Chanock RM (1967) The role of viruses, mycoplasmas, and bacteria in acute pneumonia in civilian adults. Am J Epidemiol 86:526–544Google Scholar
  4. 4.
    MacFarlane JT, Finch RG, Ward MJ, Macrae RD (1982) Hospital study of adult community-acquired pneumonia. Lancet I:255–258Google Scholar
  5. 5.
    Landsman JB (1952) Bacteraemia and prognosis in lobar pneumonia: the results of quantitative blood culture in pneumococcus pneumonia. Glasg Med J 33:33–45Google Scholar
  6. 6.
    Dowling HF, Lepper MH (1951) The effect of antibiotics (penicillin, aureomycin, and terramycin) on the fatality rate and incidence of complications in pneumococcic pneumonia. A comparison with other methods of therapy. Am J Med Sci 222:396–403Google Scholar
  7. 7.
    Tilghman RC, Finland M (1937) Clinical significance of bacteremia in pneumococcal pneumonia. Arch Intern Med 59:602–619Google Scholar
  8. 8.
    Middleton R, Gibbon JH (1930) The prognostic value of the initial leukocyte and differential count in lobar pneumonia. Am J Med Sci 180:31–36Google Scholar
  9. 9.
    Van Metre TE (1954) Pneumococcal pneumonia treated with antibiotics: the prognostic significance of certain clinical findings. N Engl J Med 251:1048–1052Google Scholar
  10. 10.
    Mufson MA, Kruss DM, Wasil RE, Metzger WI (1974) Capsular types and outcome of bacteremic pneumococcal disease in the antibiotic era. Arch Intern Med 374:505–510Google Scholar
  11. 11.
    Hook EW, Horton CA, Shaberg DR (1983) Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 249:1055–1057Google Scholar
  12. 12.
    Burman LA, Norrby R, Trollfors B (1985) Invasive pneumococcal infections: incidence, predisposing factors and prognosis. Rev Infect Dis 7:133–142Google Scholar
  13. 13.
    Hoeprich PD (1983) Bacterial pneumonias. In: Hoeprich PD (ed) Infectious diseases: modern treatise of infectious processes. Harper and Row, Philadelphia, pp 347–360Google Scholar
  14. 14.
    Le Gall J-R, Loirat P, Alperovitch A (1983) Simplified acute physiological score for intensive care patients. Lancet II:741Google Scholar
  15. 15.
    Le Gall J-R, Loirat P, Alperovitch A, Glaser P, Granthill C, Mathieu D, Mercier Ph, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977Google Scholar
  16. 16.
    Durocher A, Saulnier F, Beuscart R, Dievart R, Bart F, Deturck R, Wattel F (1988) A comparison of three severity score indexes in an evaluation of serious bacterial pneumonia. Intensive Care Med 14:39–43Google Scholar
  17. 17.
    Van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA (1988) Outcome prediction in critically ill patients by means of oxygen consumption index and simplified acute physiology score. Intensive Care Med 14:44–49Google Scholar
  18. 18.
    Wilkinson HN, Fikes BJ, Cruce DD (1979) Indirect immunofluorescence test for serodiagnosis of Legionnaire's disease: evidence for serodiversity of Legionnaire's disease bacterial antigens and for multiple specificity of human antibodies. J Clin Microbiol 9:379–383Google Scholar
  19. 19.
    Ingelfinger JA, Mosteller F, Thibodeau LA, Ware JH (1983) Biostatistics in clinical medicine. Macmillian, New York, pp 160Google Scholar
  20. 20.
    Örtqvist A, Sterner G, Nilsson JA (1985) Severe community-acquired pneumonia: factors influencing need of intensive care treatment and prognosis. Scand J Infect Dis 17:377–386Google Scholar
  21. 21.
    Thomas L (1954) The physiological disturbances produced by endotoxins. Ann Rev Physiol 16:467–490Google Scholar
  22. 22.
    Turck M, Schaberg D (1983) Infections due to Enterobacterioceae. In: Petersdorf RG, Adams RD, Braunwald E, Isselbacher KJ, Martin JB, Wilson JD (eds) Harrison's principles of internal medicine. McGraw Hill, New York, pp 945–954Google Scholar
  23. 23.
    Cohen P, Gardner FH (1966) Thrombocytopenia as a laboratory sign and complication of gram-negative bacteremic infections. Arch Intern Med 117:113–124Google Scholar
  24. 24.
    Sugerman HJ, Peyton JWR, Greenfield LJ (1981) Gram-negative sepsis, Curr Probl Surg 18:405–475Google Scholar
  25. 25.
    Bistrian BR, Blackburn GL, Scrimshaw NS, Flatt J-P (1975) Cellular immunity in semistarved states in hospitalized adults. Am J Clin Nutr 28:1148–1155Google Scholar
  26. 26.
    Hoffenberg R, Black E, Brock JF (1966) Albumin and γ-Globulin tracer studies in protein depletion states. J Clin Invest 45:143–152Google Scholar
  27. 27.
    Kirsch R, Frith L, Black E, Hoffenberg R (1968) Regulation of albumin synthesis and catabolism by alteration of dietary protein. Nature 217:578–579Google Scholar
  28. 28.
    Corman LC (1985) Effects of specific nutrients on the immune response: selected clinical applications. Med Clin North Am 69:759–791Google Scholar
  29. 29.
    Chandra RK (1983) Nutrition, immunity, and infection: present knowledge and future directions. Lancet I:688–691Google Scholar
  30. 30.
    Dinarello CA (1984) Interleukin-1 and the pathogenesis of the acute-phase response. N Engl J Med 311:1413–1418Google Scholar
  31. 31.
    British Thoracic Society (1987) The hospital management of community-acquired pneumonia. Recommendations of the British Thoracic Society. J R Coll Physicians Lond 21:267–269Google Scholar
  32. 32.
    Van Eeden SF, Coetzee AR, Joubert JR (1988) Community-acquired pneumonia — factors influencing intensive care admission. S Afr Med J 73:77–81Google Scholar
  33. 33.
    Bullowa JGM, Wilcox C (1935) Incidence of bacteremia in the pneumonias and its relation to mortality. Arch Intern Med 55:558–573Google Scholar
  34. 34.
    Gruer LD, McKendrick MW, Geddes AM (1984) Pneumococcal bacteremia — a continuing challenge. Q J Med 53:259–270Google Scholar
  35. 35.
    Sörensen J, Cederholm I, Carlsson C (1986) Pneumonia: a deadly disease despite intensive care treatment. Scand J Infect Dis 18:329–335Google Scholar
  36. 36.
    Lerner AM (1983) Klebsiella pneumoniae pneumonia In: Weinstein L, Field BN (eds) Seminars in infectious disease. Pneumonias. Thieme Stratton, New York, pp 10–15Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • C. Feldman
    • 1
    • 2
  • J. M. Kallenbach
    • 1
    • 2
  • H. Levy
    • 1
    • 2
  • S. G. Reinach
    • 4
  • M. D. Hurwitz
    • 1
    • 2
  • J. R. Thorburn
    • 1
    • 2
  • H. J. Koornhof
    • 3
  1. 1.Department of Medicine and AnaesthesiaHillbrow HospitalJohannesburgSouth Africa
  2. 2.University of the WitwatersrandJohannesburgSouth Africa
  3. 3.Department of Medical Microbiology, School of PathologySouth Africa Institute of Medical ResearchJohannesburgSouth Africa
  4. 4.Institute of Biostatistics of the South African Medical Research CouncilJohannesburgSouth Africa

Personalised recommendations