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BioMed Research International
Volume 2015, Article ID 285983, 11 pages
Review Article

Predictors of Mortality for Nursing Home-Acquired Pneumonia: A Systematic Review

1Nova Southeastern University Health Sciences Division, Fort Lauderdale, FL 33314, USA
2The Commonwealth Medical College, Scranton, PA 18509, USA
3Division of Pulmonary Medicine, Northeast Ohio Medical University College of Medicine, Rootstown, OH 44272, USA
4Division of Infectious Diseases, Medina Hospital (Cleveland Clinic), Medina, OH 44256, USA
5Division of Infectious Diseases, Northeast Ohio Medical University College of Medicine, Rootstown, OH 44272, USA
6Florida International University (FIU), North Miami Beach, FL 33181, USA
7Department of Medicine, University of California San Diego (UCSD), 200 West Arbor Drive, San Diego, CA 92103, USA

Received 20 December 2014; Revised 12 February 2015; Accepted 16 February 2015

Academic Editor: Anastasia Kotanidou

Copyright © 2015 Naveen Dhawan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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. Conclusion. 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.