Macrolide combination therapy for hospitalised CAP patients? An individualised approach supported by machine learning.
Eur Respir J. 2019 Sep 19;:
Authors: König R, Cao X, Oswald M, Forstner C, Rohde G, Rupp J, Witzenrath M, Welte T, Kolditz M, Pletz M, CAPNETZ study group
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.
PMID: 31537702 [PubMed - as supplied by publisher]