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Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia
BACKGROUND: The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated w...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054390/ https://www.ncbi.nlm.nih.gov/pubmed/30028834 http://dx.doi.org/10.1371/journal.pone.0200620 |
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author | Kim, Byunghyun Kim, Joonghee Jo, You Hwan Lee, Jae Hyuk Hwang, Ji Eun Park, Min Ji Lee, Sihyung |
author_facet | Kim, Byunghyun Kim, Joonghee Jo, You Hwan Lee, Jae Hyuk Hwang, Ji Eun Park, Min Ji Lee, Sihyung |
author_sort | Kim, Byunghyun |
collection | PubMed |
description | BACKGROUND: The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated with a good prognosis, and incorporation of UAT into CRB65 would improve its prognostic performance. METHODS: In this registry-based retrospective study, we analyzed CAP patients over a 10-year period beginning in April 2008. Patients who had UAT results were included in multivariable extended Cox-regression analyses to determine the association between UAT positivity and 30-day mortality. UAT results were incorporated for patients with a CRB65 score of 1 by subtracting 1 from the scoring system if the test was positive. The performance of the modified scoring systems was assessed with area under the receiver operating characteristic (AUROC) curves. RESULTS: Among 5145 CAP patients, total 2280 patients had UAT results and were included in analyses. A positive UAT result was associated with a good prognosis after a week of hospitalization (aHR, 0.14; p = 0.007). After modification of CRB65 using UAT results, positive and negative predictive values for 30-day mortality were increased from 7.7 to 8.3 (p<0.001) and 98.9 to 99.1 (p = 0.010). The AUROC increased from 0.73 to 0.75 (p<0.001). CONCLUSIONS: Positive results on UAT could be considered as a good prognostic factor in CAP. UAT could be used as a useful tool in deciding whether to refer patients to the hospital, especially in moderate CAP with a CRB score of 1. |
format | Online Article Text |
id | pubmed-6054390 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-60543902018-07-27 Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia Kim, Byunghyun Kim, Joonghee Jo, You Hwan Lee, Jae Hyuk Hwang, Ji Eun Park, Min Ji Lee, Sihyung PLoS One Research Article BACKGROUND: The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated with a good prognosis, and incorporation of UAT into CRB65 would improve its prognostic performance. METHODS: In this registry-based retrospective study, we analyzed CAP patients over a 10-year period beginning in April 2008. Patients who had UAT results were included in multivariable extended Cox-regression analyses to determine the association between UAT positivity and 30-day mortality. UAT results were incorporated for patients with a CRB65 score of 1 by subtracting 1 from the scoring system if the test was positive. The performance of the modified scoring systems was assessed with area under the receiver operating characteristic (AUROC) curves. RESULTS: Among 5145 CAP patients, total 2280 patients had UAT results and were included in analyses. A positive UAT result was associated with a good prognosis after a week of hospitalization (aHR, 0.14; p = 0.007). After modification of CRB65 using UAT results, positive and negative predictive values for 30-day mortality were increased from 7.7 to 8.3 (p<0.001) and 98.9 to 99.1 (p = 0.010). The AUROC increased from 0.73 to 0.75 (p<0.001). CONCLUSIONS: Positive results on UAT could be considered as a good prognostic factor in CAP. UAT could be used as a useful tool in deciding whether to refer patients to the hospital, especially in moderate CAP with a CRB score of 1. Public Library of Science 2018-07-20 /pmc/articles/PMC6054390/ /pubmed/30028834 http://dx.doi.org/10.1371/journal.pone.0200620 Text en © 2018 Kim et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kim, Byunghyun Kim, Joonghee Jo, You Hwan Lee, Jae Hyuk Hwang, Ji Eun Park, Min Ji Lee, Sihyung Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title | Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title_full | Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title_fullStr | Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title_full_unstemmed | Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title_short | Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
title_sort | prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054390/ https://www.ncbi.nlm.nih.gov/pubmed/30028834 http://dx.doi.org/10.1371/journal.pone.0200620 |
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