title: Predictors of mortality for nursing home-acquired pneumonia: a systematic review.
abstract: BACKGROUND
  Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality.
  
  
  METHODS
  PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis.
  
  
  RESULTS
  More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools.
  
  
  CONCLUSIONS
  The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.
authors.affiliation: Nova Southeastern University Health Sciences Division, Fort Lauderdale, FL 33314, USA.
authors.forename: Naveen
authors.identifier: 0000-0002-5431-2195
authors.initials: N
authors.lastname: Dhawan
authors.affiliation: Nova Southeastern University Health Sciences Division, Fort Lauderdale, FL 33314, USA.
authors.forename: Naushira
authors.initials: N
authors.lastname: Pandya
authors.affiliation: The Commonwealth Medical College, Scranton, PA 18509, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Khalili
authors.affiliation: Division of Pulmonary Medicine, Northeast Ohio Medical University College of Medicine, Rootstown, OH 44272, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bautista
authors.affiliation: Division of Infectious Diseases, Medina Hospital (Cleveland Clinic), Medina, OH 44256, USA ; Division of Infectious Diseases, Northeast Ohio Medical University College of Medicine, Rootstown, OH 44272, USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Duggal
authors.affiliation: Florida International University (FIU), North Miami Beach, FL 33181, USA.
authors.forename: Jaya
authors.initials: J
authors.lastname: Bahl
authors.affiliation: Department of Medicine, University of California San Diego (UCSD), 200 West Arbor Drive, San Diego, CA 92103, USA.
authors.forename: Vineet
authors.identifier: 0000-0003-4639-3316
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D009732:Nursing Care / Q000706:statistics & numerical data*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
references.citation: Am J Respir Crit Care Med. 2001 Mar;163(3 Pt 1):645-51
references.pmid: 11254518
references.citation: Clin Infect Dis. 2003 Nov 15;37(10):1335-9
references.pmid: 14583867
references.citation: J Am Geriatr Soc. 2009 Jun;57(6):1030-5
references.pmid: 19460091
references.citation: J Clin Endocrinol Metab. 2006 Nov;91(11):4381-6
references.pmid: 16940457
references.citation: Fam Pract Manag. 2006 Apr;13(4):41-4
references.pmid: 16671349
references.citation: Expert Rev Anti Infect Ther. 2005 Apr;3(2):263-70
references.pmid: 15918783
references.citation: Respir Care. 2014 Jul;59(7):1078-85
references.pmid: 24194575
references.citation: J Am Geriatr Soc. 1997 Jan;45(1):50-5
references.pmid: 8994487
references.citation: J Am Med Dir Assoc. 2013 Feb;14(2):109-13
references.pmid: 23206723
references.citation: BMC Med. 2012;10:7
references.pmid: 22264220
references.citation: Geriatrics. 1991 Dec;46(12):26-32
references.pmid: 1743528
references.citation: Am J Respir Crit Care Med. 2003 Jun 15;167(12):1650-4
references.pmid: 12689848
references.citation: Curr Med Res Opin. 2010 Dec;26(12):2707-14
references.pmid: 20973617
references.citation: Curr Med Res Opin. 2004 Aug;20(8):1309-20
references.pmid: 15324534
references.citation: BMC Infect Dis. 2010;10:286
references.pmid: 20920231
references.citation: J Infect. 2012 Jul;65(1):32-8
references.pmid: 22330772
references.citation: Emerg Med J. 2011 Dec;28(12):1046-50
references.pmid: 21224485
references.citation: J Am Med Dir Assoc. 2008 Feb;9(2):128-35
references.pmid: 18261707
references.citation: Infect Control Hosp Epidemiol. 2002 Mar;23(3):159-64
references.pmid: 11918125
references.citation: Curr Opin Infect Dis. 2011 Apr;24(2):148-51
references.pmid: 21252661
references.citation: Am Fam Physician. 2004 Oct 15;70(8):1495-500
references.pmid: 15526736
references.citation: Eur Respir J. 2008 Jul;32(1):12-4
references.pmid: 18591334
references.citation: Thorax. 2012 Feb;67(2):132-8
references.pmid: 22058186
references.citation: Prim Care Respir J. 2013 Jun;22(2):149-54
references.pmid: 23494188
references.citation: Chest. 2003 Jul;124(1):328-36
references.pmid: 12853541
references.citation: Am J Respir Crit Care Med. 2003 Jul 15;168(2):173-9
references.pmid: 12738607
references.citation: J Am Geriatr Soc. 2002 Mar;50(3):570-6
references.pmid: 11943058
references.citation: Thorax. 2004 May;59(5):364-6
references.pmid: 15115857
references.citation: Clin Chim Acta. 2013 Jun 5;421:226-9
references.pmid: 23454473
references.citation: Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416
references.pmid: 15699079
references.citation: Am J Respir Crit Care Med. 2006 Dec 1;174(11):1249-56
references.pmid: 16973986
references.citation: Semin Respir Infect. 2001 Mar;16(1):76-84
references.pmid: 11309715
references.citation: Chest. 1995 Nov;108(5):1288-91
references.pmid: 7587431
references.citation: J Am Geriatr Soc. 2005 May;53(5):755-61
references.pmid: 15877549
references.citation: Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72
references.pmid: 17278083
references.citation: Rev Infect Dis. 1989 Jul-Aug;11(4):586-99
references.pmid: 2772465
references.citation: J Am Geriatr Soc. 2004 Oct;52(10):1603-9
references.pmid: 15450034
references.citation: Clin Chest Med. 2005 Mar;26(1):1-9
references.pmid: 15802160
references.citation: Eur Respir J. 2003 Apr;21(4):702-5
references.pmid: 12762360
references.citation: Clin Chem. 2006 Jan;52(1):112-9
references.pmid: 16269513
references.citation: Lancet Infect Dis. 2010 Apr;10(4):279-87
references.pmid: 20334851
references.citation: J Am Geriatr Soc. 2006 Nov;54(11):1694-700
references.pmid: 17087696
references.citation: J Am Geriatr Soc. 1998 Dec;46(12):1538-44
references.pmid: 9848815
references.citation: Chest. 2010 Dec;138(6):1371-6
references.pmid: 20507947
references.citation: Int J Infect Dis. 2013 Jan;17(1):e37-43
references.pmid: 23041365
references.citation: J Am Geriatr Soc. 2000 Oct;48(10):1292-9
references.pmid: 11037018
references.citation: Clin Infect Dis. 2003 Dec 1;37(11):1405-33
references.pmid: 14614663
references.citation: Clin Interv Aging. 2014;9:267-74
references.pmid: 24611004
references.citation: Hepatology. 1990 Nov;12(5):1179-86
references.pmid: 1699862
references.citation: Thorax. 2009 Oct;64 Suppl 3:iii1-55
references.pmid: 19783532
references.citation: J Am Med Dir Assoc. 2011 Sep;12(7):499-507
references.pmid: 21450174
references.citation: Crit Care. 2008;12(2):117
references.pmid: 18355399
references.citation: Clin Microbiol Infect. 2011 Nov;17(11):1659-65
references.pmid: 21463391
references.citation: Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
references.pmid: 19622511
references.citation: Swiss Med Wkly. 2010;140:w13101
references.pmid: 20872295
references.citation: Chest. 2007 Apr;131(4):1205-15
references.pmid: 17426229
references.citation: J Am Geriatr Soc. 1986 Oct;34(10):697-702
references.pmid: 3489749
references.citation: Respir Care. 2014 Apr;59(4):574-81
references.pmid: 24106319
references.citation: Thorax. 2009 Jul;64(7):587-91
references.pmid: 19131448
references.citation: Arch Gerontol Geriatr. 2011 Nov-Dec;53(3):364-9
references.pmid: 21439658
references.citation: Eur Respir J. 2001 Aug;18(2):362-8
references.pmid: 11529297
references.citation: Thorax. 2010 Apr;65(4):354-9
references.pmid: 20388763
references.citation: Clin Infect Dis. 2008 Aug 1;47(3):375-84
references.pmid: 18558884
references.citation: Thorax. 2003 May;58(5):377-82
references.pmid: 12728155
references.citation: Geriatr Gerontol Int. 2013 Oct;13(4):949-57
references.pmid: 23441872
references.citation: Drugs Aging. 2005;22(7):577-87
references.pmid: 16038573
references.citation: J Am Geriatr Soc. 2002 Mar;50(3):439-48
references.pmid: 11943038
references.citation: J Am Med Dir Assoc. 2011 Jan;12(1):33-7
references.pmid: 21194657
references.citation: Chest. 2001 Feb;119(2 Suppl):419S-425S
references.pmid: 11171779
references.citation: Clin Infect Dis. 2000 Aug;31(2):383-421
references.pmid: 10987698
references.citation: J Fam Pract. 1998 Oct;47(4):298-304
references.pmid: 9789516
references.citation: Chest. 2004 Apr;125(4):1335-42
references.pmid: 15078743
references.citation: Age Ageing. 2006 May;35(3):286-91
references.pmid: 16638769
references.citation: Am Fam Physician. 2009 Jun 1;79(11):976-82
references.pmid: 19514695
references.citation: N Engl J Med. 1997 Jan 23;336(4):243-50
references.pmid: 8995086
references.citation: Scand J Infect Dis. 2003;35(5):306-10
references.pmid: 12875515
references.citation: J Am Med Dir Assoc. 2012 Oct;13(8):727-31
references.pmid: 22889729
references.citation: Am J Respir Crit Care Med. 1998 Oct;158(4):1102-8
references.pmid: 9769267
references.citation: Am J Respir Crit Care Med. 2001 Jun;163(7):1730-54
references.pmid: 11401897
references.citation: Emerg Health Threats J. 2008;1:e2
references.pmid: 22460211