{"title":"Development of a predictive score to discriminate community acquired pneumonia with underlying lung cancer: A retrospective case – control study","authors":"João Barbosa-Martins , Joana Mendonça , Nuno Carvalho , Carolina Carvalho , Gustavo Soutinho , Helena Sarmento , Camila Coutinho , Jorge Cotter","doi":"10.1016/j.rmed.2024.107675","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Materials and methods</h3><p>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).</p></div><div><h3>Results</h3><p>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 ≥ 232x10<sup>3</sup>/μL (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.</p></div><div><h3>Conclusion</h3><p>We propose a novel risk score aimed to aid clinicians identifying patients with CAP–uLC in the acute setting, possibly prompting early LC diagnosis.</p></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":null,"pages":null},"PeriodicalIF":3.5000,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0954611124001495","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
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/μL (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 novel risk score aimed to aid clinicians identifying patients with CAP–uLC in the acute setting, possibly prompting early LC diagnosis.
期刊介绍:
Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants.
Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.