Outcomes of Pneumonia in ICUs in Low- and Middle-Income Countries - A Systematic Review

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Pooled mortality rate 37%

• Primary Outcome: All-cause ICU, 28-day or 30-day mortality

• Nnt Or Sensitivity: Mortality increased to 61% (95% CI: 44-75%) in mechanically ventilated patients

• Confidence Interval: 95% CI: 31-42%

Clinical Application

Results provide benchmark data but limited direct clinical application for Australian practice Australian ICU mortality rates for CAP typically lower than reported figures; findings may inform resource allocation discussions and international health policy but have limited direct relevance to TGA, PBS, or RACGP guidelines Limited applicability to Australian ICU patients due to different healthcare infrastructure and patient populations

Abstract

BACKGROUND: Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) admission and death in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to estimate mortality among patients with CAP admitted to ICUs in LMICs. METHODS: We searched multiple databases using terms related to CAP admitted to the ICU and LMIC. We included both observational studies and clinical trials. The primary outcome was all-cause ICU, 28-day or 30-day mortality. Demographics, comorbidities, clinical characteristics, mechanical ventilation, and length of ICU stay were described. We registered the study in PROSPERO (CRD42022363048). RESULTS: A total of 52 studies from 18 countries met inclusion criteria, encompassing 48,707 patients. Most studies originated in upper-middle-income countries and no studies from low-income countries were identified. The most frequent comorbidities were hypertension, chronic obstructive pulmonary disease, and diabetes. Mechanical ventilation was reported in 36 studies, with median use in 59% (interquartile range, 41.4-77.4) of patients. Pooled mortality was 37% (95% confidence interval [CI], 31-42), rising to 61 (44-75) among patients requiring mechanical ventilation. In a meta-regression, age and mechanical ventilation were the strongest moderators of mortality, explaining 55.2% of heterogeneity in short-term mortality. CONCLUSIONS: Mortality among patients with CAP admitted to ICUs in middle-income countries remains high, especially in older and mechanically ventilated patients. The lack of data from low-income countries is notable.

References

1. 1.Pitrowsky, M., Pacheco, M. B., Ranzani, O., Amado, F. S., Nassar Junior, A. P., Besen, B. A. M. P., Moralez, G. M., Martins, G., Povoa, P., Lapa E Silva, J. R., & Salluh, J. I. F. (2026). Outcomes of pneumonia in ICUs in low- and middle-income countries - A systematic review. NEJM Evidence. https://doi.org/10.1056/EVIDoa2500244