School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, UK.
Thorax. 2010 Oct;65(10):884-90. doi: 10.1136/thx.2009.134072. Epub 2010 Aug 20.
Several scoring systems have been used to predict mortality in patients with community-acquired pneumonia. The properties of commonly used risk stratification scales were systematically reviewed.
MEDLINE and EMBASE (January 1999-October 2009) were searched for prospective studies that reported mortality at 4-8 weeks in patients with radiographically-confirmed community-acquired pneumonia. The search focused on the Pneumonia Severity Index (PSI) and the three main iterations of the CURB (confusion, urea nitrogen, respiratory rate, blood pressure) scale (CURB-65, CURB, CRB-65), and test performance was evaluated based on 'higher risk' categories as follows: PSI class IV/V, CURB-65 (score ≥ 3), CURB (score ≥ 2) and CRB-65 (score ≥ 2). Random effects meta-analysis was used to generate summary statistics of test performance and receiver operating characteristic curves were used for predicting mortality.
402 articles were screened and 23 studies involving 22,753 participants (average mortality 7.4%) were retrieved. The respective diagnostic odds ratios for mortality were 10.77 (PSI), 6.40 (CURB-65), 5.97 (CRB-65) and 5.75 (CURB). Overall, PSI had the highest sensitivity and lowest specificity for mortality, CRB-65 was the most specific (but least sensitive) test and CURB-65/CURB were between the two. Negative predictive values for mortality were similar among the tests, ranging from 0.94 (CRB-65) to 0.98 (PSI), whereas positive predictive values ranged from 0.14 (PSI) to 0.28 (CRB-65).
The current risk stratification scales (PSI, CURB-65, CRB-65 and CURB) have different strengths and weaknesses. All four scales had good negative predictive values for mortality in populations with a low prevalence of death but were less useful with regard to positive predictive values.
有几种评分系统被用于预测社区获得性肺炎患者的死亡率。本研究系统地评价了常用风险分层量表的特征。
检索 MEDLINE 和 EMBASE（1999 年 1 月至 2009 年 10 月）中前瞻性研究，报道经影像学证实的社区获得性肺炎患者 4-8 周死亡率。检索重点是肺炎严重指数（PSI）和 CURB（意识模糊、尿素氮、呼吸频率、血压）量表的三个主要迭代（CURB-65、CURB、CRB-65），并根据“高危”类别评价测试性能，如下：PSI 分级 IV/V、CURB-65（评分≥3）、CURB（评分≥2）和 CRB-65（评分≥2）。采用随机效应荟萃分析生成测试性能汇总统计量，采用受试者工作特征曲线预测死亡率。
筛选出 402 篇文章，检索到 23 项研究共涉及 22753 例患者（平均死亡率 7.4%）。死亡率的诊断优势比分别为 10.77（PSI）、6.40（CURB-65）、5.97（CRB-65）和 5.75（CURB）。PSI 对死亡率的敏感性最高，特异性最低，CRB-65 是最特异（但最不敏感）的测试，而 CURB-65/CURB 则介于两者之间。死亡率的阴性预测值在各试验中相似，范围为 0.94（CRB-65）至 0.98（PSI），而阳性预测值范围为 0.14（PSI）至 0.28（CRB-65）。
目前的风险分层量表（PSI、CURB-65、CRB-65 和 CURB）各有优缺点。所有四个量表在死亡率低的人群中对死亡率都有较好的阴性预测值，但阳性预测值都不高。
