E-ISSN 2149-2530
Original Article
Factors affecting cost of patients with severe community-acquired pneumonia in intensive care unit
1 Department of Anesthesia and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey  
2 Department of Chest Diseases, Akdeniz University School of Medicine, Antalya, Turkey  
3 Respiratory Intensive Care Unit, Süreyyapaşa Chest Diseases and Surgery Training and Research Hospital, İstanbul, Turkey  
4 Department of Chest Diseases, Dokuz Eylül University School of Medicine, İzmir, Turkey  
5 Clinic of Chest Diseases, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Research and Training Hospital, İstanbul, Turkey  
Turk Thorac J ; 5: -
DOI: 10.5152/TurkThoracJ.2018.18084
Key Words: intensive care unit, cost, severe community-acquired pneumonia, drug use

Objective: The aim of this study is to investigate the factors affecting cost in patients with severe community-acquired pneumonia (CAP) who admitted to the intensive care unit (ICU).

Material and Methods:
This retrospective cohort study was conducted at Süreyyapaşa Chest Diseases Training and Research Hospital, Dokuz Eylül University Hospital, Ankara University Hospital, Akdeniz University Hospital ICU between January 2013 - December 2016. A total of 291 sequential patients with severe CAP were included in the study. Patients’ demographic and clinical data, need for invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV), intensive care severity scores including APACHE-II (Acute Physiology And Chronic Health Evaluation), SOFA (Sepsis-related Organ Failure Assessment), Quick SOFA and pneumonia severity index (PSI) and CURB-65 scores were obtained from medical records and recorded for all cases.

The mean age of 291 patients was 68.4 ± 16.8 years, and 61% were female. Median length of intensive care unit stay was 7 days (1st-3rd percentiles: 4-11 days). Forty-six percent of patients had chronic obstructive pulmonary disease (COPD), and 42% had hypertension. Mean cost of each hospitalization was found as 2722 $ (5578 TL). The highest cost was found in 50-59 years-aged patient group, lowest cost was found in the <50 years-aged patients. Statistically significant relationship was found between ICU severity scores and health cost. The cost of patients in PSI group-V, APACHE-II score >20 points, and CURB-65 score ≥3 points were higher. The cost of patients in PSI class V, APACHE II (>20 points) and CURB-65 score were higher. Presence of COPD, atrial fibrillation, congestive heart failure, hypoalbuminemia, mental state deterioration, in-hospital mortality, severe sepsis, septic shock, mechanical ventilation requirement, haloperidol and vasopressor usage were associated with higher cost; while use of florokinolon was associated with lower cost.

The presence of certain comorbidities and high disease severity in patients with severe CAP hospitalized into ICU increase the cost of in-patient treatment. The need for mechanical ventilation during treatment and presence of sepsis / septic shock were other factors that increase the cost.

Key Words
Author's Corner
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