title: Prognosis of multi-lobar pneumonia in community-acquired pneumonia: a systematic review and meta-analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Medicine, Norfolk and Norwich University Hospital, Norfolk NR4 7UY, UK; Oxford University Hospitals, Oxford, OX3 7LE, UK. Electronic address: Gurdeepmannu@gmail.com.
authors.forename: Gurdeep Singh
authors.initials: GS
authors.lastname: Mannu
authors.forename: Yoon Kong
authors.initials: YK
authors.lastname: Loke
authors.forename: James Peter
authors.initials: JP
authors.lastname: Curtain
authors.forename: Kelum Nadeesha
authors.initials: KN
authors.lastname: Pelpola
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
mesh_terms: D017714:Community-Acquired Infections / Q000401:mortality*; D006801:Humans; D016017:Odds Ratio; D011014:Pneumonia / Q000401:mortality*; D011379:Prognosis; D012720:Severity of Illness Index
keywords: Community-acquired pneumonia; Complications; Multilobar pneumonia; Outcomes; Prognosis