However, nonsurvivors compared with survivors at 1 year, nonsurvivors were older, had more co-morbid conditions, as evidenced by higher Charlson scores, and had more severe CAP on presentation, as evidenced by higher Pneumonia Severity Index and APACHE III scores.
The House of Representatives has already passed the American Health Care Act that would slash Medicaid funding more than $800 billion and put a severe cap on future spending.
Garcia-Vidal and colleagues [ 19] observed that patients with severe CAP on corticosteroid therapy and equal Charlson score, PSI class, and hypotension at admission do better than those without corticosteroid therapy.
On admission, 1,135 patients (97%) met IDSA/ATS criteria for severe CAP, 991 on major criteria and 146 on minor criteria.
In overall CAP patients, there are subsets of patients with severe CAP for whom combination therapy is clearly superior compared with monotherapy: severe CAP, bacteremic pneumococcal CAP, CAP with shock, and intubated CAP patients.
Our goal was to evaluate the outcome of patients with severe CAP, focusing on the impact of new rather than old fluoroquinolones combined with β-lactam in the empirical antimicrobial treatments.
All patients who did not survive in 60-day follow-up were shown to die during hospitalization, and their death was related to severe CAP, based on the medical records.
ICU-based studies in the UK and Spain report mortality rates of 20%to50%0% in severe CAP patients, depending on admission criteria [ 11- 13].
The concept of using corticosteroids for patients with severe CAP is based on studies that should be categorized as both a weak recommendation (two studies) and a strong recommendation (two studies) with either low- or moderate-quality evidence, thus reflecting a global 'weak recommendation'.
Two small studies (n = 46 and n = 30) concentrated on severe CAP (using ATS and BTS criteria); one study found a statistically significant reduction in mortality, lengths of stay and duration of mechanical ventilation in the steroid group, but similar improvements in the other study, and in a large subgroup of patients with severe CAP in another study (n = 93) were not found.
