Prognostic implications of aspiration pneumonia in patients with community acquired pneumonia: A systematic review with meta-analysis

Kosaku Komiya, Bruce K Rubin, Jun-Ichi Kadota, Hiroshi Mukae, Tomohiro Akaba, Hiroshi Moro, Nobumasa Aoki, Hiroki Tsukada, Shingo Noguchi, Nobuaki Shime, Osamu Takahashi, Shigeru Kohno, Kosaku Komiya, Bruce K Rubin, Jun-Ichi Kadota, Hiroshi Mukae, Tomohiro Akaba, Hiroshi Moro, Nobumasa Aoki, Hiroki Tsukada, Shingo Noguchi, Nobuaki Shime, Osamu Takahashi, Shigeru Kohno

Abstract

Aspiration pneumonia is thought to be associated with a poor outcome in patients with community acquired pneumonia (CAP). However, there has been no systematic review regarding the impact of aspiration pneumonia on the outcomes in patients with CAP. This review was conducted using the MOOSE guidelines: Patients: patients defined CAP.

Exposure: aspiration pneumonia defined as pneumonia in patients who have aspiration risk. Comparison: confirmed pneumonia in patients who were not considered to be at high risk for oral aspiration.

Outcomes: mortality, hospital readmission or recurrent pneumonia. Three investigators independently identified published cohort studies from PubMed, CENTRAL database, and EMBASE. Nineteen studies were included for this systematic review. Aspiration pneumonia increased in-hospital mortality (relative risk, 3.62; 95% CI, 2.65-4.96; P < 0.001, seven studies) and 30-day mortality (3.57; 2.18-5.86; P < 0.001, five studies). In contrast, aspiration pneumonia was associated with decreased ICU mortality (relative risk, 0.40; 95% CI, 0.26-0.60; P < 0.00001, four studies). Although there are insufficient data to perform a meta-analysis on long-term mortality, recurrent pneumonia, and hospital readmission, the few reported studies suggest that aspiration pneumonia is also associated with these poor outcomes. In conclusion, aspiration pneumonia was associated with both higher in-hospital and 30-day mortality in patients with CAP outside ICU settings.

Figures

Figure 1. Flow diagram of the study…
Figure 1. Flow diagram of the study selection.
Figure 2. Pooled mean difference for in-hospital…
Figure 2. Pooled mean difference for in-hospital mortality with 95% confidence intervals for eligible studies.
Figure 3. Pooled mean difference for 30-day…
Figure 3. Pooled mean difference for 30-day mortality with 95% confidence intervals for eligible studies.
Figure 4. Pooled mean difference for ICU…
Figure 4. Pooled mean difference for ICU mortality with 95% confidence intervals for eligible studies.
Figure 5. Funnel plots for in-hospital mortality,…
Figure 5. Funnel plots for in-hospital mortality, 30-day mortality and ICU mortality.

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