Prognosis of multi-lobar pneumonia in community-acquired pneumonia: A systematic review and meta-analysis |
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| Authors: | Gurdeep Singh Mannu Yoon Kong Loke James Peter Curtain Kelum Nadeesha Pelpola Phyo Kyaw Myint |
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| Institution: | 1. Division of Medicine, Norfolk and Norwich University Hospital, Norfolk NR4 7UY, UK;2. Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK;3. Oxford University Hospitals, Oxford, OX3 7LE, UK;4. Colchester General Hospital, Turner Road, Colchester, Essex, CO4 5JL, UK;1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada;2. Department of Medicine, McMaster University, Hamilton, ON, Canada;3. IRCCS—Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy;4. Geriatric Unit, Ospedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Italy;5. Internal Medicine, IRCCS Policlinico San Donato, Department of Medical and Surgery, University of Milan, Italy;6. Biomedical Department of Internal Medicine, University of Palermo, Italy;7. Divisione I Clinica Medica, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome, Italy;8. Scientific Direction, IRCCS Ca'' Granda Maggiore Hospital Foundation, Milan, Italy |
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| Abstract: | BackgroundPneumonia is the leading cause of infection related mortality. Multilobar pneumonia (MLP) may have poorer outcomes and is a constituent of some prognostic indices. Our aim was to systematically-review and meta-analyse the impact of multi-lobar involvement in pneumonia.MethodsWe searched PubMed in June 2012 for studies reporting on the association between MLP and clinical outcomes. Potentially relevant studies were cross checked by two independent reviewers before final inclusion. Odds-ratios (OR) for the association between MLP and mortality, unfavourable outcomes, and poor treatment response were pooled using random effects meta-analysis.ResultsTwenty-two studies were included in this report. There were a total of 11,456 pneumonia patients including 2897 (25.3%) patients with MLP. As there was substantial clinical and statistical heterogeneity in the overall dataset, we limited the main meta-analysis to patients with community-acquired pneumonia (CAP). This showed that MLP was associated with increased mortality, OR 2.57 (95% CI: 1.83–3.61), with no statistical heterogeneity (I2 = 0%). Evidence from other settings suggests that MLP may also be associated with higher likelihood of other poor outcomes such as worsening clinical/radiological status, delayed resolution, and need for mechanical ventilation.ConclusionMLP appears to be an independent risk factor for mortality in CAP. It may be possible to improve commonly used prognostic indices in CAP by addition of MLP as a criterion. |
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