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

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.