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Prognosis of multi-lobar pneumonia in community-acquired pneumonia: a systematic review and meta-analysis
Gurdeep Singh Mannu1, Yoon Kong Loke, James Peter Curtain
1Division of Medicine, Norfolk and Norwich University Hospital, Norfolk NR4 7UY, UK; Oxford University Hospitals, Oxford, OX3 7LE, UK.
Background:
Pneumonia 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.
Methods:
We 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.
Results:
Twenty-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 (I(2)=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.
Conclusion:
MLP 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.
Insights
Multilobar pneumonia (MLP) significantly increases mortality risk in community-acquired pneumonia (CAP). Identifying MLP could improve patient prognoses and treatment strategies for this severe lung infection.
Area of Science:
- Infectious Diseases
- Pulmonology
- Critical Care Medicine
Background:
- Pneumonia is a leading cause of infection-related death.
- Multilobar pneumonia (MLP) is associated with worse outcomes and included in prognostic indices.
- The impact of multilobar involvement in pneumonia requires systematic review.
Purpose of the Study:
- To systematically review and meta-analyze the clinical outcomes associated with multilobar pneumonia.
- To determine if multilobar pneumonia is an independent risk factor for mortality.
Main Methods:
- A systematic literature search of PubMed was conducted in June 2012.
- Two independent reviewers screened studies for relevance.
- Random effects meta-analysis was used to pool odds ratios for MLP and clinical outcomes.
Main Results:
- Twenty-two studies comprising 11,456 patients were analyzed.
- Multilobar pneumonia was present in 25.3% of patients.
- In community-acquired pneumonia (CAP), MLP significantly increased mortality (OR 2.57, 95% CI: 1.83-3.61) with no heterogeneity.
Conclusions:
- Multilobar pneumonia is an independent risk factor for mortality in CAP.
- Incorporating MLP into prognostic indices may enhance their accuracy.
- MLP is linked to other adverse outcomes like worsening status and need for ventilation.
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