Clinical Characteristics and Outcomes of Patients with Severe Community Acquired Pneumonia in A Tertiary Care Hospital: An Observational Study

INTRODUCTION: Community Acquired Pneumonia (CAP) is a commonly encountered disease, one third of which is severe Community Acquired Pneumonia (SCAP) that can be life threatening. SCAP remains a frequent reason for admission to hospital and escalation of treatment including intensive care unit (ICU) admission. The mortality rate of patients of SCAP admitted to ICU may be over 30% depending on multiple factors (1). There is insufficient information regarding SCAP in Indian population. Thus the aim of the study is to observe outcomes of SCAP in a tertiary hospital setting, risk factors, mode of respiratory support in patients with SCAP. OBJECTIVES: To observe the mortality in patients with SCAP. ICU length of stay. Risk factors. Type of respiratory support. MATERIALS AND METHODS: This is a prospective observational single center study conducted at Intensive Care Unit of Fortis Escort heart institute Okhla, New Delhi from September 2023 to November 2024 after obtaining approval from Institutional Ethical Committee. 50 patients were admitted to our hospital ICU with the diagnosis of SCAP in accordance to the criteria of American Thoracic Society Guidelines (2001). The patients underwent clinical and diagnostic evaluations to detect the severity of illness as well as the aetiology and other risk factors influencing the eventual outcome of SCAP. RESULTS: Data was tabulated and analyzed by proper statistical tests. Mean age of the participants was 68 years. In ICU mortality in SCAP in our study is 16% which is lower than predicted mortality by APACHE II score (vs 25%, average APACHE II score 19). mean length of ICU stay is 4.65 days. While etiology was not found in 56% of participants, 12% grew streptococcus pneumoniae in their cultures, 22% had gram negative bacteria (klebsiella pneumoniae> Escherichia Coli>Pseudomonas Aeruginosa) and 10% had H1N1 viral influenza infections. 66% patients were initially managed with non-invasive ventilations (NIV), 8% participants were managed with high flow nasal cannula (HFNC)/conventional oxygen therapy, 26% participants were managed with invasive ventilation as means of initial respiratory support. Mortality was 8% in invasive ventilation group and 12% in NIV group. CONCLUSION: A significant finding of our study is the association of GNBs with SCAP which are usually associated with hospital acquired pneumonia. This highlights the importance of a development of local pneumonia guidelines focusing on its aetiology and management. This study also indicates that while NIV is frequently utilized in SCAP patients, it has a notable crossover rate to invasive ventilation and significant mortality in both groups. These findings suggest that there is significant mortality in both groups and we should remain careful in selecting NIV as a mode of initial respiratory support in patients with SCAP.