Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility
Atypical pneumonia, driven by pathogens like Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila, is challenging to diagnose due to non-specific symptoms. This systematic review assessed the diagnostic accuracy and prognostic value of biomarkers in atypical pneumonia. A comprehe...
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PAGEPress Publications
2025-06-01
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| Series: | Monaldi Archives for Chest Disease |
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| Online Access: | https://www.monaldi-archives.org/macd/article/view/3564 |
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| author | Debashis Priyadarshan Sahoo Bikash Ranjan Rout |
| author_facet | Debashis Priyadarshan Sahoo Bikash Ranjan Rout |
| author_sort | Debashis Priyadarshan Sahoo |
| collection | DOAJ |
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Atypical pneumonia, driven by pathogens like Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila, is challenging to diagnose due to non-specific symptoms. This systematic review assessed the diagnostic accuracy and prognostic value of biomarkers in atypical pneumonia. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar (2000-2024) identified 27 studies, including observational, cohort, case-control, and review designs. Studies focused on biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, and pathogen-specific antibodies, with quality evaluated using the Newcastle-Ottawa Scale and AMSTAR 2. CRP was elevated in 85% of cases, with a pooled sensitivity of 82.3% [95% confidence interval (CI) 76.5-88.1, I²=78%] but moderate specificity (65.2%, 95% CI 58.0-72.4). PCT exhibited high specificity (88.7%, 95% CI 83.2-94.2, I²=65%) for bacterial etiologies, making it valuable for distinguishing bacterial from viral infections. Anti-Mycoplasma pneumoniae immunoglobulin M (IgM) showed excellent diagnostic accuracy (sensitivity 90.1%, 95% CI 85.0-95.2). Ferritin levels >400 ng/mL were strongly associated with severe outcomes [odds ratio (OR) 3.15, 95% CI 2.10-4.72, I²=70%]. Elevated biomarkers correlated with increased hospitalization (OR 2.78, 95% CI 1.95-3.96) and mortality (OR 3.42, 95% CI 2.30-5.08). Heterogeneity was significant (I²=65-78%), reflecting variability in study populations and methods. PCT and anti-Mycoplasma pneumoniae IgM enhance diagnostic precision, while ferritin and CRP are robust prognostic markers. Standardized biomarker thresholds are essential to optimize their clinical utility and improve patient outcomes in atypical pneumonia management.
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| format | Article |
| id | doaj-art-e771d3b5ef9f433fa4340859bd0e35d1 |
| institution | Kabale University |
| issn | 1122-0643 2532-5264 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | PAGEPress Publications |
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| series | Monaldi Archives for Chest Disease |
| spelling | doaj-art-e771d3b5ef9f433fa4340859bd0e35d12025-08-20T03:28:22ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642025-06-0110.4081/monaldi.2025.3564Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utilityDebashis Priyadarshan Sahoo0https://orcid.org/0000-0002-6198-0626Bikash Ranjan Rout1https://orcid.org/0009-0001-3609-2037All India Institute of Medical Sciences, GuwahatiBarasat Government Medical College, Banamalipur, Kolkata Atypical pneumonia, driven by pathogens like Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila, is challenging to diagnose due to non-specific symptoms. This systematic review assessed the diagnostic accuracy and prognostic value of biomarkers in atypical pneumonia. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar (2000-2024) identified 27 studies, including observational, cohort, case-control, and review designs. Studies focused on biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, and pathogen-specific antibodies, with quality evaluated using the Newcastle-Ottawa Scale and AMSTAR 2. CRP was elevated in 85% of cases, with a pooled sensitivity of 82.3% [95% confidence interval (CI) 76.5-88.1, I²=78%] but moderate specificity (65.2%, 95% CI 58.0-72.4). PCT exhibited high specificity (88.7%, 95% CI 83.2-94.2, I²=65%) for bacterial etiologies, making it valuable for distinguishing bacterial from viral infections. Anti-Mycoplasma pneumoniae immunoglobulin M (IgM) showed excellent diagnostic accuracy (sensitivity 90.1%, 95% CI 85.0-95.2). Ferritin levels >400 ng/mL were strongly associated with severe outcomes [odds ratio (OR) 3.15, 95% CI 2.10-4.72, I²=70%]. Elevated biomarkers correlated with increased hospitalization (OR 2.78, 95% CI 1.95-3.96) and mortality (OR 3.42, 95% CI 2.30-5.08). Heterogeneity was significant (I²=65-78%), reflecting variability in study populations and methods. PCT and anti-Mycoplasma pneumoniae IgM enhance diagnostic precision, while ferritin and CRP are robust prognostic markers. Standardized biomarker thresholds are essential to optimize their clinical utility and improve patient outcomes in atypical pneumonia management. https://www.monaldi-archives.org/macd/article/view/3564Atypical pneumoniabiomarkersC-reactive proteinprocalcitoninferritinmycoplasma pneumoniae |
| spellingShingle | Debashis Priyadarshan Sahoo Bikash Ranjan Rout Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility Monaldi Archives for Chest Disease Atypical pneumonia biomarkers C-reactive protein procalcitonin ferritin mycoplasma pneumoniae |
| title | Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility |
| title_full | Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility |
| title_fullStr | Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility |
| title_full_unstemmed | Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility |
| title_short | Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility |
| title_sort | biomarkers in atypical pneumonia a systematic review of diagnostic and prognostic utility |
| topic | Atypical pneumonia biomarkers C-reactive protein procalcitonin ferritin mycoplasma pneumoniae |
| url | https://www.monaldi-archives.org/macd/article/view/3564 |
| work_keys_str_mv | AT debashispriyadarshansahoo biomarkersinatypicalpneumoniaasystematicreviewofdiagnosticandprognosticutility AT bikashranjanrout biomarkersinatypicalpneumoniaasystematicreviewofdiagnosticandprognosticutility |