多个评估系统对社区获得性肺炎严重度评估的荟萃分析

doi:10.16150/j.1671-2870.2016.06.009

摘要/Abstract

摘要： 目的: 通过分析已有的临床数据,观察多个评估系统对社区获得性肺炎（community acquired pneumonia,CAP）患者30 d的死亡风险和ICU入住风险的预测价值。方法: 用关键词途径对2004年至2015年的PubMed和EMBASE数据库进行文献检索,并对符合条件的所有研究进行荟萃分析。结果: 共纳入文献48篇,共51 639例CAP患者采用各评价系统对其30 d死亡风险进行评估,共评估了10 590例CAP患者入住ICU的风险。通过汇总计算得出,对于30 d死亡风险的预测,CRB-65（confusion,respiratory,age 65 years）评分系统的灵敏度为98%,特异度为33%,综合受试者工作特征（summary receiver operating characteristic,sROC）曲线下面积为0.56;英国胸科协会改良肺炎评分(confusion, uremia, respiratory,blood pressure, age 65 years, CURB-65评分)系统的灵敏度为84%,特异度为55%,sROC曲线下面积为0.78;肺炎严重度指数(pneumonia severity index, PSI)系统的灵敏度为90%,特异度为57%,sROC曲线下面积为0.88;以符合2007美国感染病学会(Infectious Diseases Society of America,IDSA) /美国胸科学会（American Thoracic Society, ATS) 3项以上次要标准且不符合主要标准的评估灵敏度为76%,特异度为90%,sROC曲线下面积为0.89;采用SMART-COP评估的灵敏度为77%,特异度为65%,sROC曲线下面积为0.67。对于入住ICU风险,采用CURB-65系统评估的灵敏度为52%,特异度为77%,sROC曲线下面积为0.67;采用PSI系统评估的灵敏度为70%,特异度为61%,sROC曲线下面积为0.69;采用SMART-COP评分评估的灵敏度为84%,特异度为70%,sROC曲线下面积为0.74。结论: PSI、CURB-65评分系统对患者30 d死亡风险的预测价值较大,可作为住院标准的重要参考。对于收住ICU的风险评估,SMART-COP的预测价值相对较大,而PSI、CURB-65评分价值相对较低。

关键词: 社区获得性肺炎, 预测价值, 荟萃分析

Abstract: Objective: To review and analyze the value of various severity scale system for predicting 30 day mortality and ICU admission in community acquired pneumonia (CAP) patients via meta-analysis. Methods: MEDLINE and EMBASE (2004-2015) were retrieved and 48 papers were collected. Altogether 51 639 CAP patients were enrolled for predicting 30 day mortality, and 10 590 CAP patients were enrolled for predicting ICU admission. The values of five severity scale system: CRB-65, CURB-65, PSI, 2007 IDSA/ATS, SMART-COP for predicting 30 day mortality and ICU admission were meta-analyzed. Results: For predicting 30 day mortality, CRB-65 had a sensitivity of 98%; specificity of 33% and area under summary receiver operator characteristic (sROC) curve (AUC) 0.56. For CURB-65, the above mentioned indices were 84%, 55% and 0.78, respectively. PSI(pneumonia severity index) had a sensitivity of 90%, specificity of 57% and area under sROC curve 0.88; the above mentioned indices for 2007 IDSA/ATS were 76%, 90% and 0.89, respectively. For predicting ICU admission. CURB-65 had a sensitivity of 52%, specificity of 77% and area under sROC 0.67; the above mentioned indices for PSI were 70%, 61%and 0.69, respectively. The SMART-COP had a sensitivity of 84%, specificity of 70%, and area under sROC curve 0.74. Conclusions: PSI, CURB-65 could be used as important references for predicting 30 day mortality in patients with CAP. For ICU admission, the prediction value of SMART-COP is relatively better than PSI and CURB-65 scale systems.

Key words: Community-acquired pneumonia, Prediction value, Meta-analysis

中图分类号:

R563.1

冯耘, 程挺, 刘嘉琳, 万欢英, 程齐俭. 多个评估系统对社区获得性肺炎严重度评估的荟萃分析[J]. 诊断学理论与实践, 2016, 15(06): 586-594.

FENG Yun, CHENG Ting, LIU Jialin, WAN Huanying, CHENG Qijian. Validation and meta-analysis of various severity scale system for predicting mortality and ICU admission in community-acquired pneumonia patients[J]. Journal of Diagnostics Concepts & Practice, 2016, 15(06): 586-594.

参考文献

[1] Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update2009[J]. Thorax,2009,64 Suppl 3:iii1-55.
[2] Leeper KV Jr.Severe community-acquired pneumonia[J]. Semin Respir Infect,1996,11(2):96-108.
[3] Bauer TT, Ewig S, Marre R, et al.CRB-65 predicts death from community-acquired pneumonia[J]. J Intern Med,2006, 260:93-101.
[4] Capelastegui A, España PP, Quintana JM, et al.Validation of a predictive rule for the management of community-acquired pneumonia[J]. Eur Respir J,2006,27(1):151-157.
[5] Barlow G, Nathwani D, Davey P.The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia[J]. Thorax,2007,62(3):253-259.
[6] Man SY, Lee N, Ip M, et al.Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong[J]. Thorax,2007, 62(4):348-353.
[7] Zuberi FF, Khan JA.Prospective comparison of prediction rules of mortality risk for CAP in a developing country[J]. Int J Tuberc Lung Dis,2008,12(4):447-452.
[8] Schuetz P, Koller M, Christ-Crain M, et al.Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings[J]. Epidemiol Infect,2008,136(12):1628-1637.
[9] Menéndez R, Martínez R, Reyes S, et al.Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia[J]. Thorax,2009,64(7):587-591.
[10] Karmakar G, Wilsher M.Use of the 'CURB 65' score in hospital practice[J]. Intern Med J,2010,40(12):828-832.
[11] Ronan D, Nathwani D, Davey P, et al.Predicting mortality in patients with community-acquired pneumonia and low CURB-65 scores[J]. Eur J Clin Microbiol Infect Dis,2010,29(9):1117-1124.
[12] Dwyer R, Hedlund J, Darenberg J, et al.Improvement of CRB-65 as a prognostic scoring system in adult patients with bacteraemic pneumococcal pneumonia[J]. Scand J Infect Dis,2011,43(6-7):448-455.
[13] Guo Q, Li HY, Zhou YP, et al.Weight of the CURB-65 criteria for community-acquired pneumonia in a very low-mortality-rate setting[J]. Intern Med,2012,51(18):2521-2527.
[14] Nüllmann H, Pflug MA, Wesemann T, et al.External validation of the CURSI criteria (confusion, urea, respiratory rate and shock index) in adults hospitalised for community-acquired pneumonia[J]. BMC Infect Dis,2014,14:39.
[15] Aujesky D, Auble TE, Yealy DM, et al.Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia[J]. Am J Med,2005, 118(4):384-392.
[16] Challen K, Bright J, Bentley A, et al.Physiological-social score (PMEWS) vs. CURB-65 to triage pandemic influenza: a comparative validation study using community-acquired pneumonia as a proxy[J]. BMC Health Serv Res,2007,7:33.
[17] Ananda-Rajah MR, Charles PG, Melvani S, et al.Comparing the pneumonia severity index with CURB-65 in patients admitted with community acquired pneumonia[J]. Scand J Infect Dis,2008,40(4):293-300.
[18] Charles PG, Wolfe R, Whitby M, et al.SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia[J]. Clin Infect Dis,2008,47(3):375-384.
[19] Shindo Y, Sato S, Maruyama E, et al.Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia[J]. Respirology,2008,13(5):731-735.
[20] Claessens YE, Mathevon T, Kierzek G, et al.Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia[J]. Intensive Care Med,2010,36(5):799-809.
[21] España PP, Capelastegui A, Quintana JM, et al.Validation and comparison of SCAP as a predictive score for identifying low-risk patients in community-acquired pneumonia[J]. J Infect,2010,60(2):106-113.
[22] Abisheganaden J, Ding YY, Chong WF, et al.Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index[J]. Respirology,2012,17(6):969-975.
[23] Luque S, Gea J, Saballs P, et al.Prospective comparison of severity scores for predicting mortality in community-acquired pneumonia[J]. Rev Esp Quimioter,2012,25(2):147-154.
[24] Kim HI, Kim SW, Chang HH, et al.Mortality of community-acquired pneumonia in Korea: assessed with the pneumonia severity index and the CURB-65 score[J]. J Korean Med Sci,2013,28(9):1276-1282.
[25] Mbata GC, Chukwuka CJ, Onyedum CC, et al.The CURB-65 scoring system in severity assessment of Eas-tern Nigerian patients with community-acquired pneumonia: a prospective observational study[J]. Prim Care Respir J,2013,22(2):175-180.
[26] Alavi-Moghaddam M, Bakhshi H, Rezaei B, et al.Pneumonia severity index compared to CURB-65 in predicting the outcome of community acquired pneumonia among patients referred to an Iranian emergency department: a prospective survey[J]. Braz J Infect Dis,2013,17(2):179-183.
[27] Ribeiro C, Ladeira I, Gaio AR, et al.Pneumococcal pneumonia-Are the new severity scores more accurate in predicting adverse outcomes?[J]. Rev Port Pneumol,2013, 19(6):252-259.
[28] Varshochi M, Kianmehr P, Naghavi-Behzad M, et al.Correspondence between hospital admission and the pneumonia severity index(PSI), CURB-65 criteria and comparison of their predictive value in mortality and hospital stay[J]. Infez Med,2013,21(2):103-110.
[29] Yin Q, Liu B, Chen Y, et al.Soluble thrombomodulin to evaluate the severity and outcome of community-acquired pneumonia[J]. Inflammation 2014,37(4):1271-1279.
[30] van der Eerden MM, de Graaff CS, Bronsveld W, et al. Prospective evaluation of pneumonia severity index in hospitalised patients with community-acquired pneumonia[J]. Respir Med,2004,98(9):872-878.
[31] Mortensen EM, Restrepo MI, Anzueto A, et al.The effect of prior statin use on 30-day mortality for patients hospitalized with community-acquired pneumonia[J]. Respir Res,2005,6:82.
[32] Ortega L, Sierra M, Domínguez J, et al.Utility of a pneumonia severity index in the optimization of the diagnostic and therapeutic effort for community-acquired pneumonia[J]. Scand J Infect Dis,2005,37(9):657-663.
[33] Buising KL, Thursky KA, Black JF, et al.A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia[J]. Thorax,2006,61(5):419-424.
[34] Naito T, Suda T, Yasuda K, et al.A validation and potential modification of the pneumonia severity index in elderly patients with community-acquired pneumonia[J]. J Am Geriatr Soc,2006,54:1212-1219.
[35] Renaud B, Coma E, Hayon J, et al.Investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes: a European study[J]. Clin Microbiol Infect,2007,13(9):923-931.
[36] Huang DT, Weissfeld LA, Kellum JA, et al.Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia[J]. Ann Emerg Med,2008,52(1):48-58.
[37] Johnstone J, Eurich DT, Majumdar SR, et al.Long-term morbidity and mortality after hospitalization with community-acquired pneumonia: a population-based cohort study[J]. Medicine (Baltimore),2008,87(6):329-334.
[38] Chen CZ, Fan PS, Lin CC, et al.Repeated pneumonia severity index measurement after admission increases its predictive value for mortality in severe community-acquired pneumonia[J]. J Formos Med Assoc,2009,108(3):219-223.
[39] Robins-Browne KL, Cheng AC, Thomas KA, et al.The SMART-COP score performs well for pneumonia risk stratification in Australia's Tropical Northern Territory: a prospective cohort study[J]. Trop Med Int Health,2012, 17(7):914-919
[40] Suberviola B, Castellanos-Ortega A, Llorca J, et al.Prognostic value of proadrenomedullin in severe sepsis and septic shock patients with community-acquired pneumonia[J]. Swiss Med Wkly,2012,142:w13542.
[41] Kohno S, Seki M, Takehara K, et al.Prediction of requirement for mechanical ventilation in community-acquired pneumonia with acute respiratory failure: a multicenter prospective study[J]. Respiration,2013,85(1):27-35.
[42] Fernandez-Botran R, Uriarte SM, Arnold FW, et al.Contrasting inflammatory responses in severe and non-severe community-acquired pneumonia[J]. Inflammation,2014, 37(4):1158-1166.
[43] Davis JS, Cross GB, Charles PG, et al.Pneumonia risk stratification in tropical Australia: does the SMART-COP score apply?[J]. Med J Aust,2010,192(3):133-136.
[44] Phua J, See KC, Chan YH, et al.Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia[J]. Thorax,2009,64(7):598-603.
[45] Park SY, Park S, Lee MG, et al.Minor criteria of Infectious Disease Society Of America/American Thoracic Society for severe community-acquired pneumonia can predict delayed treatment response[J]. J Korean Med Sci,2012,27(8):907-913.
[46] Garau J, Baquero F, Pérez-Trallero E, et al.Factors impacting on length of stay and mortality of community-acquired pneumonia[J]. Clin Microbiol Infect,2008,14(4):322-329.
[47] Chalmers JD, Singanayagam A, Akram AR, et al.Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis[J]. Thorax,2010,65(10):878-883.
[48] Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study[J]. Thorax,2003,58(5):377-382.
[49] Serisier DJ, Williams S, Bowler SD.Australasian respiratory and emergency physicians do not use the pneumonia severity index in community-acquired pneumonia[J]. Respirology,2013,18(2):291-296.
[50] Eccles S, Pincus C, Higgins B, et al.Diagnosis and mana-gement of community and hospital acquired pneumonia in adults: summary of NICE guidance[J]. BMJ,2014,349:g6722.
[51] 余跃天, 朱琤, 毛恩强, 等. 阿托伐他丁对缺血性脑卒中患者医院获得性肺炎的影响[J]. 诊断学理论与实践,2015,14(2):169-174.
[52] Singanayagam A, Chalmers JD, Hill AT.Severity assessment in community-acquired pneumonia: a review[J]. QJM,2009,102(6):379-388.
[53] Marti C, Garin N, Grosgurin O, et al.Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis[J]. Crit Care,2012,16(4):R141.
[54] Riquelme R, Jiménez P, Videla AJ, et al.Predicting mortality in hospitalized patients with 2009 H1N1 influenza pneumonia[J]. Int J Tuberc Lung Dis,2011,15(4):542-546.
[55] Bjarnason A, Thorleifsdottir G, Löve A, et al.Severity of influenza A 2009 (H1N1) pneumonia is underestimated by routine prediction rules. Results from a prospective, po-pulation-based study[J]. PLoS One,2012,7(10):e46816.
[56] Myles PR, Nguyen-van-Tam JS, Lim WS, et al. Comparison of CATs, CURB-65 and PMEWS as triage tools in pandemic influenza admissions to UK hospitals: case control analysis using retrospective data[J]. PLoS One,2012,7(4):e34428.
[57] Muller MP, McGeer AJ, Hassan K, et al. Evaluation of pneumonia severity and acute physiology scores to predict ICU admission and mortality in patients hospitalized for influenza[J]. PLoS One,2010,5(3):e9563.
[58] 尹玉东, 曹彬. 社区获得性肺炎诊治指南解读: 从病情严重度分层角度[J]. 中国循证医学杂志,2015,15(7):756-760.

编辑推荐 0

Metrics

阅读次数

全文

132

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	0	0	0	132

来源	本网站	其他网站

次数	78	54
比例	59%	41%

摘要

265

最新录用	在线预览	正式出版

0	0	264

来源	本网站	其他网站

次数	131	134
比例	49%	51%