Utility of pneumonia severity assessment tools for mortality prediction in healthcare-associated pneumonia: a systematic review and meta-analysis

Author:

Noguchi Shingo1,Katsurada Masahiro2,Yatera Kazuhiro3,Xu Dongjie4,Nakagawa Natsuki5,Fukuda Yosuke6,Shindo Yuichiro7,Senda Kazuyoshi8,Tsukada Hiroki9,Miki Makoto4,Mukae Hiroshi10

Affiliation:

1. Tobata General Hospital

2. Kita-Harima Medical Center

3. University of Occupational and Environmental Health

4. Sendai Red Cross Hospital

5. University of Tokyo Hospital

6. Showa University

7. Nagoya University

8. Kinjo Gakuin University

9. Jikei University Kashiwa hospital

10. Nagasaki University

Abstract

Abstract Accurate prognostic tools for mortality in patients with healthcare-associated pneumonia (HCAP) are needed to provide appropriate medical care. Tools like PSI, A-DROP, I-ROAD, and CURB-65, widely used for predicting mortality in community-acquired and hospital-acquired pneumonia cases, remain controversial. We identified articles evaluating either PSI, A-DROP, I-ROAD, or CURB-65 and the mortality outcome in patients with HCAP and calculated the pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratios, and the overall summary area under the curves (AUCs) for mortality prediction. Additionally, the differences in prognostic power among these four assessment tools were evaluated using the mean differences of AUCs. Using a cut-off value of moderate, sensitivity, specificity, PLR, and NLR were found to be 0.91-0.97, 0.15-0.53, 1.14-1.66, and 0.18-0.33. respectively. Upon using a cut-off value of severe, sensitivity, specificity, PLR, and NLR were 0.63-0.70, 0.53-0.66, 1.49-2.03, and 0.47-0.58, respectively. Overall AUCs were 0.70 (0.68-0.72), 0.71 (0.63-0.78), 0.68 (0.63-0.73), and 0.67 (0.63-0.71), respectively, for PSI, A-DROP, I-ROAD, and CURB-65 (p=0.63). In conclusions, these severity assessment tools do not have enough power to predict mortality in HCAP patients. Furthermore, there are no significant differences in predictive performance among these four severity assessment tools.

Publisher

Research Square Platform LLC

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