Development of a Predictive Score to Discriminate Community Acquired Pneumonia with Underlying Lung Cancer: A Retrospective Case - Control Study
Abstract
BACKGROUND
A pneumonic infiltrate might hide an occult lung cancer (LC). This awareness depends on each clinician personal experience, turning definitive LC diagnosis challenging and possibly delayed. In this study we aimed to develop a clinical score to better identify those cases.
MATERIALS AND METHODS
We conducted a retrospective case-control study, including previously undiagnosed LC patients admitted in our institution, with a presumptive suspicious of community acquired pneumonia (CAP). Cases were compared with random CAP inpatient controls, using a matched 2:1 ratio. Demographic, clinical, and laboratorial variables were assessed for a possible association with the presence of a CAP with underlying LC (CAP-uLC).
RESULTS
Among 535 hospitalized LC patients, 43 cases had a presentation compatible with CAP and were compared with 86 CAP controls. A scoring system was built using 6 independent variables, which positively correlated with CAP-uLC: smoking history (OR: 8.3 [1.9-36.2]; p=0.005); absence of fever (6.5 [2.0-21.5]; p=0.002); sputum with blood (5.9 [1.2-29.9]; p=0.033); platelet count ≥ 232x103/uL (5.8 [1.6-20.6]; p=0.006); putative alternative diagnosis than CAP (4.6 [1.5-14.7]; p=0.009); and duration of symptoms ≥ 10 days (3.7 [1.1-13.0]; p=0.037). Our score presented an AUC of 0.910 (95% CI, 0.852-0.967; p<0.001), a sensitivity of 88.1% and specificity of 84.7%, in predicting the risk of presenting a CAP-uLC, when set to a cutoff of 18.
CONCLUSION
We propose a…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 535 participants or records.
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