Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis

被引:260
作者
Chalmers, James D. [1 ,2 ]
Singanayagam, Aran [1 ]
Akram, Ahsan R. [1 ]
Mandal, Pallavi [1 ]
Short, Philip M. [3 ]
Choudhury, Gourab [1 ]
Wood, Victoria [2 ]
Hill, Adam T. [1 ]
机构
[1] Royal Infirm Edinburgh NHS Trust, Dept Resp Med, Edinburgh EH16 4SA, Midlothian, Scotland
[2] Univ Edinburgh, Edinburgh, Midlothian, Scotland
[3] Univ Dundee, Tayside, Scotland
基金
英国医学研究理事会;
关键词
LOW-RISK PATIENTS; LENGTH-OF-STAY; EMERGENCY-DEPARTMENT; INDEX; VALIDATION; MANAGEMENT; RULES; OUTCOMES; PROGNOSIS; DECISION;
D O I
10.1136/thx.2009.133280
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Introduction International guidelines recommend a severity-based approach to management in community-acquired pneumonia. CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended severity scores. The aim of this study was to compare the performance characteristics of these scores for predicting mortality in community-acquired pneumonia. Methods A systematic review and meta-analysis was conducted according to MOOSE (meta-analysis of observational studies in epidemiology) guidelines. PUBMED and EMBASE were searched (1980-2009). 40 studies reporting prognostic information for the PSI, CURB65 and CRB65 severity scores were identified. Performance characteristics were pooled using a random effects model. Relationships between sensitivity and specificity were plotted using summary receiver operator characteristic (sROC) curves. Results All three scores predicted 30 day mortality. The PSI had the highest area under the sROC curve, 0.81 (SE 0.008), compared with CURB65, 0.80 (SE 0.008), p=0.1, and CRB65, 0.79 (0.01), p=0.09. These differences were not statistically significant. Performance characteristics were similar across comparable cut-offs for low, intermediate and high risk for each score. In identifying low risk patients, PSI (groups I and II) had the best negative likelihood ratio 0.08 (0.06-0.12) compared with CURB65 (score 0-1) 0.21 (0.15-0.30) and CRB65 (score 0), 0.15 (0.10-0.22). Conclusion There were no significant differences in overall test performance between PSI, CURB65 and CRB65 for predicting mortality from community-acquired pneumonia.
引用
收藏
页码:878 / 883
页数:6
相关论文
共 61 条
  • [1] Alfageme I, 2005, ARCH BRONCONEUMOL, V41, P272
  • [2] Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia
    Ananda-Rajah, Michelle R.
    Charles, Patrick G. P.
    Melvani, Sharmila
    Burrell, Laurelle L.
    Johnson, Paul D. R.
    Grayson, M. Lindsay
    [J]. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, 2008, 40 (04) : 293 - 300
  • [3] Severe community-acquired pneumonia - Use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria
    Angus, DC
    Marrie, TJ
    Obrosky, DS
    Clermont, G
    Dremsizov, TT
    Coley, C
    Fine, MJ
    Singer, DE
    Kapoor, WN
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 166 (05) : 717 - 723
  • [4] Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia
    Aujesky, D
    Auble, TE
    Yealy, DM
    Stone, RA
    Obrosky, DS
    Meehan, TP
    Graff, LG
    Fine, JM
    Fine, MJ
    [J]. AMERICAN JOURNAL OF MEDICINE, 2005, 118 (04) : 384 - 392
  • [5] The Pneumonia Severity Index: A Decade after the Initial Derivation and Validation
    Aujesky, Drahomir
    Fine, Michael J.
    [J]. CLINICAL INFECTIOUS DISEASES, 2008, 47 : S133 - S139
  • [6] The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia
    Barlow, Gavin
    Nathwani, Dilip
    Davey, Peter
    [J]. THORAX, 2007, 62 (03) : 253 - 259
  • [7] CRB-65 predicts death from community-acquired pneumonia
    Bauer, T. T.
    Ewig, S.
    Marre, R.
    Suttorp, N.
    Welte, T.
    [J]. JOURNAL OF INTERNAL MEDICINE, 2006, 260 (01) : 93 - 101
  • [8] Predicting death in elderly patients with community-acquired pneumonia: A prospective validation study reevaluating the CRB-65 severity assessment tool
    Bont, Jettie
    Hak, Eelko
    Hoes, Arno W.
    Macfarlane, John T.
    Verheij, Theo J. M.
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2008, 168 (13) : 1465 - 1468
  • [9] *BRAZ SOC INF DIS, 2002, BRAZ J INFECT DIS, V6, P82
  • [10] Identifying severe community-acquired pneumonia in the emergency department: A simple clinical prediction tool
    Buising, Kirsty L.
    Thursky, Karin A.
    Black, James F.
    MacGregor, Lachlan
    Street, Alan C.
    Kennedy, Marcus P.
    Brown, Graham V.
    [J]. EMERGENCY MEDICINE AUSTRALASIA, 2007, 19 (05) : 418 - 426