Predictors of mortality in severe pneumonia patients: A systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background: Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods: Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle-Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results: In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P<0.00001], male gender [odds ratio (OR)=1.46, 95% CI (1.06, 2.01), P=0.02] and risk of death from severe pneumonia. The comorbidity of neoplasm [OR=3.37, 95% CI (1.07, 10.57), P=0.04], besides the presence of complications such as diastolic hypotension [OR=2.60, 95% CI (1.45, 4.66), P=0.001], ALI/ARDS [OR=3.65, 95% CI (1.80, 7.40), P=0.0003], septic shock [OR=9.43, 95% CI (4.39, 20.28), P<0.00001], MOF [OR=4.32, 95% CI (2.35, 7.94), P<0.00001], acute kidney injury [OR=2.45, 95% CI (1.14, 5.26), P=0.02], and metabolic acidosis [OR=5.88, 95% CI (1.51, 22.88), P=0.01] were associated with significantly higher risk of death amongst patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: +67.77 mmol/L, 95% CI (47.21, 88.34), P<0.00001], blood urea nitrogen [BUN: +6.26 mmol/L, 95% CI (1.49, 11.03), P=0.01], C-reactive protein [CRP: +33.09 mg/L, 95% CI (3.01, 63.18), P=0.03], leukopenia [OR=2.95, 95% CI (1.40, 6.23), P=0.005], Sodium < 136 mEq/L [OR=2.89, 95% CI (1.17, 7.15), P=0.02], albumin [-5.17 g/L, 95% CI (-7.09, -3.25), P<0.00001], PaO2/ FiO2 [-55.05 mmHg, 95% CI (-60.11, -50.00), P<0.00001], arterial blood PH [-0.09, 95% CI (-0.15, -0.04), P=0.0005], gram-negative microorganism [OR=2.57, 95% CI (1.15, 5.73), P=0.02], multilobar or bilateral involvement [OR=3.68, 95% CI (2.71, 5.00), P<0.00001] and bilateral chest X-ray involvement [OR=2.21, 95% CI (1.13, 4.31), P=0.02]. Conclusions: Older age, male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, multilobar or bilateral involvement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.046 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".