• Mariano Esperatti, Nora Fuentes, Miquel Ferrer, Otavio T Ranzani, Gianluigi Li Bassi, Mervyn Singer, Maria Eugenia Gonzalez, Georgina Peraita, Maria Soledad Urbano, and Antoni Torres.
• Hospital Privado de Comunidad, Mar del Plata, Argentina; Escuela de Medicina, Universidad Nacional de Mar del Plata, Mar del Plata, Argentina. Electronic address: marianoesperatti@gmail.com.
• J Crit Care. 2020 Oct 1; 59: 207-214.

PurposeWe explore the hypothesis that critically ill patients developing ICU-acquired pneumonia (ICU-AP) have worse outcomes and an altered inflammatory response if their ICU admission was sepsis-related.MethodsProspective cohort study in two centers. Patients with ICU-AP were evaluated according to their previous exposure to sepsis at ICU-admission. Demographic variables, comorbidities, severity scores at admission and at the time of acquisition of ICU-AP, and serum biomarkers of the inflammatory response were evaluated.Primary Outcome90-day mortality.Secondary OutcomesICU and hospital length of stay, mortality at days 28 and 180, in-hospital mortality, ventilator-free days (day-28), and inflammatory response. Propensity scoring weighted the risk of previously-acquired sepsis. Multivariate analysis evaluated the risk of mortality by day-90. Sensitivity analyses evaluated the primary outcome in different subgroups.ResultsOf 341 patients enrolled, 147 had sepsis on ICU-admission. Adjusted risk of mortality at 90 days did not differ overall [hazard ratio (HR) = 0.94(CI:0.65-1.37)], nor in subpopulations with a confirmed etiology of pneumonia [HR = 0.93(CI:0.57-1.53)] or sepsis [HR = 0.91(0.54-1.55)], ventilator-associated pneumonia (VAP) [HR = 1.01(CI:0.61-1.68)], nor non-VAP ICU-AP [HR = 0.83(CI:0.40-1.71)]. No differences were found in clinical secondary outcomes, the inflammatory response was similar.ConclusionsPrevious sepsis does not appear to predispose to higher mortality nor worse outcomes in patients who develop ICU-acquired pneumonia.Copyright © 2020. Published by Elsevier Inc.

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