Hospital acquired pneumonia: A multivariate analysis of risk and outcome

Abstract

Hospital acquired pneumonia (HAP) is one of the most leading hospital-acquired infections with substantial morbidity and mortality. Analysis of the association between different risk factors and outcome in 'HAP' patients will help in understanding the different levels of risks and permit a more rational and effective method of treatment. A prospective observational study, carried out in a tertiary care teaching hospital. HAP patients were identified during daily visits to the emergency wards and were followed from the day of diagnosis to till the day of discharge/death. Patient data like demography, medical history, medication history, co-morbid disease, etiological 
factors and clinical outcome were recorded in patient case record form. Risk factors were analyzed for their association with outcome by multiple logistic regression. 318 patients were enrolled in the study and among those 277 patients improved and discharged; remaining 41 expired. Patients who were ventilated during their stay in the hospital were 27.6% and those nonventilated were 72.4%. In the multivariate analysis, the strongest association with mortality was found for ventilation (Odds Ratio: 6.4; 95% Confidence Interval: 2.7-15.2; p<0.001), immunosuppression (OR: 3.4; 95% CI: 1.0-11.2; p<0.05) and male sex (OR: 2.9; 95% CI: 0.9-8.8; p<0.05). Study suggests that mechanical ventilation, immunosuppression and male sex are the independent risk factors with significant effect on mortality.