• J Y Fagon, J Chastre, A Vuagnat, J L Trouillet, A Novara, and C Gibert.
• Service de Réanimation Médicale, Hôpital Bichat, Paris, France.
• JAMA. 1996 Mar 20;275(11):866-9.

ObjectiveTo evaluate the role that nosocomial pneumonia plays in the outcome of intensive care unit (ICU) patients.DesignCohort study.SettingMedical ICU, Hôpital Bichat, Paris, France, an academic tertiary care center.PatientsA total of 1978 consecutive patients admitted to the ICU for at least 48 hours.Main Outcome MeasuresVarious parameters known to be strongly associated with death of ICU patients were recorded: age, location before admission to the ICU, diagnostic categories, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiologic Score, McCabe score, number and type of dysfunctional organs, and the development of nosocomial bacteremia and nosocomial urinary tract infection. These variables and the presence or absence of nosocomial pneumonia were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles.ResultsNosocomial pneumonia developed in 328 patients (16.6%) whose mortality was 52.4% compared with 22.4% for patients without ICU-acquired pneumonia (P < .001), APACHE II score (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.06 to 1.10; P < .001), number of dysfunctional organs (OR = 1.54; 95% CI, 1.36 to 1.74; P < .001), nosocomial pneumonia (OR = 2.08; 95% CI, 1.55 to 2.80; P < .001), nosocomial bacteremia (OR = 2.51; 95% CI, 1.78 to 3.55; P < .001), ultimately or rapidly fatal underlying disease (OR = 1.76; 95% CI, 1.38 to 2.25; P < .001), and admission from another ICU (OR = 1.30; 95% CI, 1.01 to 1.68; P =.04) were significantly associated with mortality.ConclusionThese data suggest that, in addition to the severity of underlying medical conditions and nosocomial bacteremia, nosocomial pneumonia independently contributes to ICU patient mortality.

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