Journal of Medical and Surgical Intensive Care Medicine 2016 , Vol 7, Issue 2
Prognostic Value of Unchangeable Risk Factors for and the Radiologic Scoring System in Ventilator-Associated Pneumonia
Nesrin Öcal 1 , Serhat Özer 1 , Gürhan Taşkın 1 , Hüseyin Levent Yamanel 1 , Ramazan Öcal 2 , Deniz Doğan 3
1Gülhane Eğitim ve Araştırma Hastanesi, Yoğun Bakım Bilim Dalı, Ankara, Türkiye
2Gazi Üniversitesi Tıp Fakültesi, Hematoloji Anabilim Dalı, Ankara, Türkiye
3Gülhane Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Anabilim Dalı, Ankara, Türkiye
DOI : 10.5152/dcbybd.2016.1194

Objective: There are insufficient data in the literature on the comparative evaluation of unchangeable risk factors for ventilator-associated pneumonia (VAP), such as the personal characteristics and/or the existing features of patients on admission to the intensive care unit, together with radiographic findings. In this study, we aimed to investigate mortality risk factors and the possible prognostic role of radiological extent of pneumonia in patients with VAP.

Material and Methods: Data on patients treated with mechanical ventilation in the intensive care unit were retrospectively evaluated. Among these, chest radiographs of patients with VAP were scored. Data were compared in terms of mortality.

Results: Older age, higher average ventilator days, admission to the intensive care unit due to chronic obstructive pulmonary diseases (COPD) exacerbations, steroid use, concomitant COPD, and chronic renal failure were observed as risk factors for VAP development. On the other hand, older age, prolonged mechanical ventilation, re-intubation, admission to the intensive care unit due to acute renal failure, and concomitant diabetes mellitus were identified as mortality risk factors for VAP. Radiographic scores were significantly higher in patients with a history of steroid use, patients hospitalized in the intensive care unit due to COPD, and patients with concomitant chronic renal failure (p=0.05, p=0.002, and p=0.045, respectively). Significant positive correlations were observed between age and ventilator days and also between radiographic scores and ventilator period (p=0.001 and p=0.03, respectively). A high total radiographic score was considered as a statistically significant prognostic marker for VAP in terms of mortality (p=0.005).


Conclusion: In light of our results, the recommended radiologic scoring system can be used as a prognostic marker in patients with VAP.  To our knowledge, this study is the first to focus on the comparative evaluation of unchangeable risk factors for VAP together with radiographic findings. We believe that it would be useful in clinical practice with a new perspective. 

Keywords : Ventilator-associated pneumonia, prognosis, mortality, risk factors, radiology, scoring method