Background: Acute respiratory failure (ARF) and severe sepsis (SS) are possible complications in patients with\ncommunity-acquired pneumonia (CAP). The aim of the study was to evaluate prevalence, characteristics, risk factors\nand impact on mortality of hospitalized patients with CAP according to the presence of ARF and SS on admission.\nMethods: This was a multicenter, observational, prospective study of consecutive CAP patients admitted to three\nhospitals in Italy, Spain, and Scotland between 2008 and 2010. Three groups of patients were identified: those with\nneither ARF nor SS (Group A), those with only ARF (Group B) and those with both ARF and SS (Group C) on\nadmission.\nResults: Among the 2,145 patients enrolled, 45% belonged to Group A, 36% to Group B and 20% to Group C.\nPatients in Group C were more severe than patients in Group B. Isolated ARF was correlated with age (p < 0.001),\nCOPD (p < 0.001) and multilobar infiltrates (p < 0.001). The contemporary occurrence of ARF and SS was associated\nwith age (p = 0.002), residency in nursing home (p = 0.007), COPD (p < 0.001), multilobar involvement (p < 0.001)\nand renal disease (p < 0.001). 4.2% of patients in Group A died, 9.3% in Group B and 26% in Group C, p < 0.001.\nAfter adjustment, the presence of only ARF had an OR for in-hospital mortality of 1.85 (p = 0.011) and the presence\nof both ARF and SS had an OR of 6.32 (p < 0.001).\nConclusions: The identification of ARF and SS on hospital admission can help physicians in classifying CAP patients\ninto three different clinical phenotypes
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