Year: 2006
Type: letter
Abstract: TO THE EDITOR—We congratulate Dr. Bodi and colleagues for their recent article [1], which demonstrates a significant association between the use of guideline-concordant antibiotics and mortality for patients with community-acquired pneumonia who require hospitalization in an intensive care unit. However, we wish to correct an error in their article regarding our recent article [2] in the American Journal of Medicine. In the discussion, the authors state that “the effects of other factors such as age, presence of comorbidities, and complications associated with pneumonia (e.g., septic shock and receipt of mechanical ventilation) were not analyzed” [1, p. 1714]. This is incorrect. Comorbid conditions and age are part of the pneumonia severity index developed by Fine et al. [3], which was included in our multivariable models. The pneumonia severity index is a validated prediction rule for 30-day mortality for patients with community-acquired pneumonia. This rule is based on 3 demographic characteristics, 5 comorbid illnesses, 5 physical examination findings, and 7 laboratory results and radiographic findings obtained at the time of presentation. Age, chronic renal disease, liver disease, congestive heart failure, prior stroke, and neoplasia are all components of the pneumonia severity index. Regarding adjusting for complications associated with pneumonia, although we did not adjust for these 2 factors directly, we included a dichotomized variable for the need of hospitalization in an intensive care unit as one of the factors in our multivariable analyses. We found that need for hospitalization in an intensive care unit was a much stronger predictor of mortality than was either septic shock or mechanical ventilation as individual variables. In addition, we were unable to put all of these factors in the same multivariable models as a result of colinearity, because both septic shock and mechanical ventilation are reasons for admission into an intensive care unit. Howard Hughes Medical Institute (faculty start-up grant 00378-001 to E.M.M.), Department of Veteran Affairs Veterans Integrated Service Network 17 (new faculty grant to E.M.M), and Department of Veteran Affairs (grant HFP98-002 to J.P). Potential conflicts of interest. All authors: no conflicts.
Source: Clinical Infectious Diseases
DOI: 10.1086/503307
Institution: South Texas Veterans Health Care System
Language: French
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,763
OpenAlex ID: W2003978605