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Abstract
Objective To identify and synthesise relevant existing prognostic factors (PF) and prediction models (PM) for hospitalisation and all-cause mortality within 90 days in primary care patients with acute lower respiratory tract infections (LRTI).
Design Systematic review.
Methods Systematic searches of MEDLINE, Embase and the Cochrane Library were performed. All PF and PM studies on the risk of hospitalisation or all-cause mortality within 90 days in adult primary care LRTI patients were included. The risk of bias was assessed using the Quality in Prognostic Studies tool and Prediction Model Risk Of Bias Assessment Tool tools for PF and PM studies, respectively. The results of included PF and PM studies were descriptively summarised.
Results Of 2799 unique records identified, 16 were included: 9 PF studies, 6 PM studies and 1 combination of both. The risk of bias was judged high for all studies, mainly due to limitations in the analysis domain. Based on reported multivariable associations in PF studies, increasing age, sex, current smoking, diabetes, a history of stroke, cancer or heart failure, previous hospitalisation, influenza vaccination (negative association), current use of systemic corticosteroids, recent antibiotic use, respiratory rate ≥25/min and diagnosis of pneumonia were identified as most promising candidate predictors. One newly developed PM was externally validated (c statistic 0.74, 95% CI 0.71 to 0.78) whereas the previously hospital-derived CRB-65 was externally validated in primary care in five studies (c statistic ranging from 0.72 (95% CI 0.63 to 0.81) to 0.79 (95% CI 0.65 to 0.92)). None of the PM studies reported measures of model calibration.
Conclusions Implementation of existing models for individualised risk prediction of 90-day hospitalisation or mortality in primary care LRTI patients in everyday practice is hampered by incomplete assessment of model performance. The identified candidate predictors provide useful information for clinicians and warrant consideration when developing or updating PMs using state-of-the-art development and validation techniques.
PROSPERO registration number CRD42022341233.
- Respiratory infections
- Primary Care
- Prognosis
- Systematic Review
Data availability statement
Data are available upon reasonable request. Study materials (eg, template data collection forms, data extracted from included studies) are available from the corresponding author upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data are available upon reasonable request. Study materials (eg, template data collection forms, data extracted from included studies) are available from the corresponding author upon reasonable request.
Supplementary materials
Supplementary Data
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Footnotes
Twitter @TamaraPlatteel1, @gjgeersing
MvS and RPV contributed equally.
Contributors MHR, TNP, MvS and RV were involved in the conceptualisation and design of the study. MHR, TMCvdB and TNP conducted the study selection procedure. Data of eligible studies was extracted by MHR. MHR, TNP and MvS performed the risk of bias assessment. MHR wrote the first draft of the manuscript, which was initially reviewed by TNP, MvS and RV. MHR, TNP, TMCvdB, G-JG, PL, FHR, MvS and RV reviewed and approved the final manuscript. As guarantor, MHR declares that this manuscript is an honest, accurate, and transparant account of the study, and accepts full responsibility for its conduct and reporting.
Funding This study was funded by ZonMw (grant number 08391052110003). The funder played no role in study design, data collection, analysis and interpretation of data, or the writing of this manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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