Predictors of mortality in invasive pneumococcal disease: a meta-analysis

ABSTRACT

Objectives

To assess risk factors for mortality in invasive pneumococcal disease (IPD).

Methods

We conducted a systemic literature search in January 2019. The main outcome measure included death within 30 days after diagnosis of IPD. The study protocol was registered in PROSPERO (CRD42019120189).

Results

After reviewing 2514 potentially relevant records, remaining 190 articles were included in the analysis. A total of 228,782 IPD patients were identified and the mortality rate was 17.2% in the included articles. No significant evidence of publication bias was found according to the funnel plot and Egger’s test (t = 1.464, p = 0.145). Male sex, older age, alcohol abuse, previous tuberculosis, meningitis, hospital acquired infections, multilobar infiltrate or effusion, Pitt bacteremia score≥4, Pneumonia Severity Index≥4, clinical conditions requiring intensive care, underlying clinical conditions, disease caused by serotypes 3, 6B, 9 N, 10A, 11A, 16 F, 17 F, 19, 19 F, 22 F, 23A, 23 F, 31 and 35 F, previous antibiotic use, inappropriate initial antibiotic therapy, penicillin resistance, and vancomycin use during the course of treatment were predicators of 30-day mortality.

Conclusions

This meta-analysis highlights important risk factors for IPD-related mortality, many of which may be targeted through preventive measures.

KEYWORDS:

• Invasive pneumococcal disease
• meta-analysis
• mortality
• pneumococcal infection
• risk factors
• streptococcus pneumoniae

Author contributions

TD and PS designed study and researched data. BE analyzed the data statistically. TD and PS interpreted the data. PS wrote the manuscript. TD and PS reviewed and edited the manuscript. Authors declare that there is no conflict of interest. All authors have read and approved the final manuscript.

List of abbreviations

CI	=	Confidence intervals
COPD	=	Chronic obstructive pulmonary disease
ART	=	Antiretroviral therapy
HIV	=	Human immunodeficiency virus
IPD	=	Invasive pneumococcal disease
NOS	=	Newcastle-Ottowa Scale
PCV	=	Pneumococcal conjugate vaccine
PPSV	=	Pneumococcal polysaccharide vaccine
OR	=	Odds ratio
S. pneumoniae	=	Streptococcus pneumoniae

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.