Table 2.
Summary estimates of the performance of physical examination, chest radiography, laboratory values, and CPIS for the diagnosis of ventilator-associated pneumonia, relative to reference standard of histopathology from lung biopsy
| No. of cohorts (patients) | Sensitivity, % (95% CI) | Specificity, % (95% CI) | Diagnostic odds ratio (95% CI) | Positive likelihood ratio (95% CI) | Negative likelihood ratio (95% CI) | GRADE | |
|---|---|---|---|---|---|---|---|
| Histopathology reference standard | |||||||
| Fever | 5 (142) | 66.4 (40.7–85) | 53.9 (34.5–72.2) | 2.31 (0.98–5.43) | 1.44 (1.01–2.05) | 0.62 (0.36–1.09) | Low |
| Purulent secretions | 4 (336) | 77 (64.7–85.9) | 39 (25.8–54) | 2.13 (1.34–3.41) | 1.26 (1.06–1.5) | 0.59 (0.42–0.83) | Moderate |
| Infiltrate on chest radiography | 7 (238) | 88.9 (73.9–95.8) | 26.1 (15.1–41.4) | 2.83 (1.18–6.82) | 1.2 (1.03–1.4) | 0.42 (0.2–0.92) | Low |
| Leukocytosis | 3 (88) | 64.2 (46.9–78.4) | 59.2 (45–72) | 2.6 (1.05–6.45) | 1.57 (1.03 to 2.4) | 0.61 (0.36–1.01) | Low |
| Sputum from endotracheal aspirate (> 105 CFU/mL) | 3 (75) | 75.7 (51.5–90.1) | 67.9 (40.5–86.8) | 6.59 (2.17–20.04) | 2.36 (1.19–4.66) | 0.36 (0.18–0.73) | Very Low |
| Protected specimen brush (> 103 CFU/mL) | 7 (201) | 61.4 (43.7–76.5) | 76.5 (64.2–85.6) | 5.19 (2.31–11.65) | 2.62 (1.63–4.19) | 0.5 (0.33–0.77) | Low |
| Bronchoalveolar lavage (> 104 CFU/mL) | 10 (307) | 71.1 (49.9–85.9) | 79.6 (66.2–88.6) | 9.57 (4.04–22.71) | 3.48 (2.13–5.7) | 0.36 (0.2–0.66) | Low |
| CPIS > 6 | 4 (343) | 73.8 (50.6–88.5) | 66.4 (43.9–83.3) | 5.56 (1.30–23.84) | 2.2 (1.09–4.43) | 0.4 (0.17–0.92) | Low |
CFU = colony-forming units; CI = confidence interval; CPIS = Clinical Pulmonary Infection Score; GRADE = Grading of Recommendations, Assessments, Development and Evaluation