Abstract
Background The role of macrolide/beta-lactam combination therapy in community-acquired pneumonia (CAP) of moderate severity is a matter of debate. Macrolides expand the coverage to atypical pathogens and attenuate pulmonary inflammation, but have been associated with cardiovascular toxicity and drug interactions. We developed a decision tree based on etiological and clinical parameters, which are available ex ante to support a personalised decision pro or con macrolides for the best clinical outcome of the individual patient.
Methods We employed machine learning in a cross-validation scheme based on a well balanced selection of 4898 patients after propensity score matching to data available on admission of 6440 hospitalised patients with moderate severity (non-ICU patients) from the observational, prospective, multinational CAPNETZ study. We aimed to improve the primary outcome of 180 days survival.
Results We found a simple decision tree of patient characteristics comprising chronic cardiovascular and chronic respiratory co-morbidities as well as leukocyte counts in the respiratory secretion at enrolment. Specifically, we found that patients without cardiovascular or patients with respiratory co-morbidities and high leukocyte counts in the respiratory secretion benefit from macrolide treatment. Patients identified to be treated in compliance with our treatment suggestion had a lower mortality of 27% (OR=1.83, CI=[1.48, 2.27], p<0.001) compared to the observed standard of care.
Conclusion Stratifying macrolide treatment in patients following a simple treatment rule may lead to considerably reduced mortality in community-acquired pneumonia. A future randomised controlled trial confirming our result is necessary before implementing this rule into the clinical routine.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. König has nothing to disclose.
Conflict of interest: Dr. Cao has nothing to disclose.
Conflict of interest: Dr. Oswald has nothing to disclose.
Conflict of interest: Dr. Forstner has nothing to disclose.
Conflict of interest: Dr. Rohde has nothing to disclose.
Conflict of interest: Dr. Rupp has nothing to disclose.
Conflict of interest: Dr. Witzenrath has nothing to disclose.
Conflict of interest: Dr. Welte has nothing to disclose.
Conflict of interest: Dr. Kolditz has nothing to disclose.
Conflict of interest: Dr. Pletz has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Copyright ©ERS 2019