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- Title
Pneumonia Severity Assessment Tools for Predicting Mortality in Patients with Healthcare-Associated Pneumonia: A Systematic Review and Meta-Analysis.
- Authors
Noguchi, Shingo; Yatera, Kazuhiro; Kawanami, Toshinori; Fujino, Yoshihisa; Moro, Hiroshi; aoki, Nobumasa; Komiya, Kosaku; Kadota, Jun-ichi; Shime, Nobuaki; Tsukada, Hiroki; Kohno, Shigeru; Mukae, Hiroshi
- Abstract
Background: In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice. Objectives: In this review, we assessed the clinical significance of severity assessment tools for HCAP. Methods: We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP. Results: Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥ IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥ IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥ 2 and ≥ 3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥ 2 and ≥ 3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients. Conclusions: The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.
- Subjects
PNEUMONIA-related mortality; CROSS infection; MEDLINE; META-analysis; ONLINE information services; PNEUMONIA; REFERENCE values; SYSTEMATIC reviews; COMMUNITY-acquired pneumonia; SEVERITY of illness index; DESCRIPTIVE statistics; IMMUNOCOMPROMISED patients; ODDS ratio
- Publication
Respiration, 2017, Vol 93, Issue 6, p441
- ISSN
0025-7931
- Publication type
Article
- DOI
10.1159/000470915