University of Edinburgh, Edinburgh, UK.
Thorax. 2010 Oct;65(10):878-83. doi: 10.1136/thx.2009.133280. Epub 2010 Aug 20.
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.
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.
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).
There were no significant differences in overall test performance between PSI, CURB65 and CRB65 for predicting mortality from community-acquired pneumonia.
国际指南建议根据严重程度对社区获得性肺炎进行管理。 CURB65、CRB65 和肺炎严重指数（PSI）是最广泛推荐的严重程度评分。本研究旨在比较这些评分预测社区获得性肺炎死亡率的性能特征。
根据 MOOSE（流行病学观察研究的荟萃分析）指南进行系统评价和荟萃分析。搜索 PUBMED 和 EMBASE（1980-2009 年）。确定了 40 项报告 PSI、CURB65 和 CRB65 严重程度评分预后信息的研究。使用随机效应模型汇总性能特征。使用汇总接收器操作特性（sROC）曲线绘制灵敏度和特异性之间的关系。
所有三个评分均预测 30 天死亡率。PSI 的 sROC 曲线下面积最高，为 0.81（SE 0.008），而 CURB65 为 0.80（SE 0.008），p=0.1，CRB65 为 0.79（0.01），p=0.09。这些差异没有统计学意义。对于每个评分的低、中、高风险，性能特征在可比截断值上相似。在识别低危患者时，PSI（组 I 和 II）的负似然比最佳，为 0.08（0.06-0.12），而 CURB65（评分 0-1）为 0.21（0.15-0.30），CRB65（评分 0）为 0.15（0.10-0.22）。
PSI、CURB65 和 CRB65 预测社区获得性肺炎死亡率的总体检测性能无显著差异。
