Comparison of clinical parameters with APACHE-II, Sequential Organ Failure Assessment and Clinical Pulmonary Infection Score scores in predicting treatment outcome of patients with ventilator associated pneumonia


  • Raveendra K. R. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Devamsh G. N. Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Nandan Kodur Department of Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Chirag L. U. Department of Medicine, Gauhati Medical College, Guwahati, Assam, India
  • Vinay K. Department of Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India



APACHE II, Clinical pulmonary infection score, Sequential organ failure assessment, Ventilator associated pneumonia


Background: The objective of this study was to study the multiple clinical parameters in patients with VAP and to compare the 3 scores namely, APACHE II, SOFA and CPIS in predicting the treatment outcome of patients with ventilator associated pneumonia.

Methods: It was a cross sectional observational study conducted on forty patients admitted in ICU between June 2018 and July 2019, who developed VAP after admission to ICU. Logistic regression analysis was applied to estimate the predictive ability of the APACHE II, SOFA and CPIS scoring systems in assessing VAP-related mortality. A p value of <0.05 was considered significant. All analyses were performed using SPSS software version 10.

Results: The sample size in our study was 40 patients. The mean age of patients was 43.4±15.9. The mean duration of mechanical ventilation before VAP onset was 8±2 days. Klebsiella species was the most common organism isolated from ET aspirate. Of the three scores only APACHE II was independent predictor of the mortality in the logistic regression analysis.

Conclusions: APACHE II score is better at predicting mortality in patients with VAP as compared to SOFA and CPIS scores. Age, co-morbidities, duration of ICU stay, time of acquiring VAP, multi organ dysfunction, need for ionotropes and multi drug resistant organisms play an important role in predicting the outcome of patients.


Joseph NM, Sistla S, Dutta TK, Badhe AS, Rasitha D, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: role of multi-drug resistant pathogens. J Infect Devel Countr. 2010 Jan 18;4(04):218-25.

Alp E, Voss A. Ventilator associated pneumonia and infection control. Ann Clini Microbiol Antimicrob. 2006 Jan 1;5(1):7.

Yang W, He B, Zhao MW. The changing patterns and the associated factors of microbial pathogens in ventilator associated pneumonia in a respiratory intensive care unit from 1995 to 2004. Zhonghua Jie He He Hu Xi Za Zhi. 2008 Aug;31(8):598-602.

Gadani H, Vyas A, Kar AK. A study of ventilator-associated pneumonia: Incidence, outcome, risk factors and measures to be taken for prevention. Ind J Anaesth. 2010;54(6):535-40.

Set R, Bobade O, Shastri J. Bacteriological profile among patients with ventilator-associated pneumonia from a medical intensive care unit at a tertiary care centre in Mumbai. Ind J Pathol Microbiol. 2011 May;54(2):432-3.

Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: A nine months' prospective study. Ann Thora Med. 2007 Apr;2(2):52.

Rello J, Sa-Borges M, Correa H, Leal SR, Baraibar J. Variations in etiology of ventilator-associated pneumonia across four treatment sites: implications for antimicrobial prescribing practices. Am J Resp Crit Care Medi. 1999 Aug 1;160(2):608-13.

Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: incidence and risk factors. J Infect Dev Ctries. 2009 Dec15;3(10):771-7.

Leal-Noval SR, Marquez-Vácaro JA, Garcia-Curiel A, Camacho-Laraña P, Rincón-Ferrari MD, Ordoñez-Fernández A, et al. Nosocomial pneumonia in patients undergoing heart surgery. Crit Care Medi. 2000 Apr 1;28(4):935-40.

Rajasekhar T, Anuradha K, Suhasini T, Lakshmi V. The role of quantitative cultures of non-brochoscopic samples in ventilator associated pneumonia. Ind J Med Microbiol. 2006 Apr;24(2):107-13.

Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator associated pneumonia at a tertiary care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol. 2003 Nov;24(11):864-69.

Moreira MR, Gontijo Filho PP. Multidrug-resistant pathogens causing ventilator associated pneumonia: Risk factors, empirical antimicrobial therapy and outcome of patients in an intensive care unit (ICU) of a Brazilian university hospital. Int J Med Med Sci. 2012;4(9):204-10.

Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care intensive care unit: Analysis of incidence, risk factors and mortality. Indian journal of critical care medicine: peer-reviewed, official publication of Ind Soc Crit Care Medi. 2014 Apr;18(4):200.

Werarak P, Waiwarawut J, Tharavichitkul P, Pothirat C, Rungruanghiranya S, Geater SL, et al. Acinetobacter baumannii nosocomial pneumonia in tertiary care hospitals in Thailand. J Med Assoc Thai. 2012 Feb 1;95(Suppl 2):S23-33.






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