title: Biomarkers for predicting short-term mortality in community-acquired pneumonia: A systematic review and meta-analysis.
abstract: OBJECTIVE
  The pneumonia severity index and CURB-65 are risk assessment tools widely used in community-acquired pneumonia (CAP). However, limitations in these prognostic scores have led to increasing interest in finding biomarkers that might provide additional information. To date, the role of these biomarkers has not been fully elucidated.
  
  
  METHODS
  We systematically searched the Medline, Web of Knowledge, Science Direct, and LILACS databases. We included studies that assessed the accuracy of biomarkers for the prediction of in-hospital or ≤30-day mortality, in hospitalized adults with CAP. Two independent investigators extracted patient and study characteristics, which were thereafter pooled using a random effects model. Relationships between sensitivity and specificity of biomarkers and prognostic scores were plotter using the area under the receiver operator characteristic curve (AUC).
  
  
  RESULTS
  We included 24 articles and 2 databases from 1069 reviewed abstracts, which provided 10,319 patients for analysis. Reported mortality rates varied from 2.4% to 34.6%. The highest AUC values for predicting mortality were associated with pro-adrenomedullin (0.80) and prohormone forms of atrial natriuretic peptide (0.79), followed by cortisol (0.78), procalcitonin (0.75), copeptin (0.71), and C-reactive protein (0.62). There were no statistically significant differences between the AUCs of the studied biomarkers, other than for copeptin and C-reactive protein, which performed comparatively poorly. When compared with the CAP-specific scores, the AUCs were not significantly different from those of most biomarkers.
  
  
  CONCLUSIONS
  The identified biomarkers are able to predict mortality with moderate to good accuracy in CAP. However, biomarkers have no clear advantage over CAP-specific scores for predicting mortality.
authors.affiliation: Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia. Electronic address: dviasus@uninorte.edu.co.
authors.forename: Diego
authors.initials: D
authors.lastname: Viasus
authors.affiliation: Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia.
authors.forename: Gaspar
authors.initials: G
authors.lastname: Del Rio-Pertuz
authors.affiliation: Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain.
authors.forename: Antonella F
authors.initials: AF
authors.lastname: Simonetti
authors.affiliation: Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Garcia-Vidal
authors.affiliation: Department of Public Health, Universidad del Norte, and Hospital Universidad del Norte, Colombia.
authors.forename: Jorge
authors.initials: J
authors.lastname: Acosta-Reyes
authors.affiliation: Clínica Medilaser S.A. - Sucursal Florencia, Fundación Universitaria Navarra, Colombia.
authors.forename: Argenis
authors.initials: A
authors.lastname: Garavito
authors.affiliation: Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain; Clinical Science Department, Faculty of Medicine, University of Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Carratalà
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000473:pathology*; D003661:Decision Support Techniques; D006801:Humans; D011014:Pneumonia / Q000175:diagnosis* / Q000473:pathology*; D011379:Prognosis; D012680:Sensitivity and Specificity; D016019:Survival Analysis
chemical_list: D015415:Biomarkers
keywords: Biomarker; Community-acquired pneumonia; Meta-analysis; Mortality