Noguchi Shingo, Yatera Kazuhiro, Kawanami Toshinori, Fujino Yoshihisa, Moro Hiroshi, Aoki Nobumasa, Komiya Kosaku, Kadota Jun-Ichi, Shime Nobuaki, Tsukada Hiroki, Kohno Shigeru, Mukae Hiroshi
Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan.
Respiration. 2017;93(6):441-450. doi: 10.1159/000470915. Epub 2017 Apr 28.
In contrast to community-acquired pneumonia (CAP), no specific severity assessment tools have been developed for healthcare-associated pneumonia (HCAP) in clinical practice.
In this review, we assessed the clinical significance of severity assessment tools for HCAP.
We identified related articles from the PubMed database. The eligibility criteria were original research articles evaluating severity scoring tools and reporting the outcomes of mortality in patients with HCAP.
Eight articles were included in the meta-analysis. The PORT score and CURB-65 were evaluated in 7 and 8 studies, respectively. Using cutoff values of ≥IV and V for the PORT score, the diagnostic odds ratios (DORs) were 5.28 (2.49-11.17) and 3.76 (2.88-4.92), respectively, and the areas under the curve (AUCs) were 0.68 (0.64-0.72) and 0.71 (0.67-0.75), respectively. Conversely, the AUCs for ≥IV and V were 0.71 (0.67-0.76) and 0.74 (0.70-0.78), respectively, when applied only to nonimmunocompromised patients. In contrast, when using cutoff values of ≥2 and ≥3 for CURB-65, the DORs were 3.35 (2.26-4.97) and 2.65 (2.05-3.43), respectively, and the AUCs were 0.65 (0.61-0.69) and 0.66 (0.62-0.70), respectively. Conversely, the AUCs for ≥2 and ≥3 were 0.65 (0.61-0.69) and 0.68 (0.64-0.72), respectively, when applied only to nonimmunocompromised patients.
The PORT score and CURB-65 do not have substantial power compared with the tools for CAP patients, although the PORT score is more useful than CURB-65 for predicting mortality in HCAP patients. According to our results, however, these tools, especially the PORT score, can be more useful when limited to nonimmunocompromised patients.
与社区获得性肺炎（CAP）不同，在临床实践中尚未开发出针对医疗保健相关肺炎（HCAP）的特定严重程度评估工具。
在本综述中，我们评估了HCAP严重程度评估工具的临床意义。
我们从PubMed数据库中识别相关文章。纳入标准为评估严重程度评分工具并报告HCAP患者死亡率结果的原始研究文章。
八项文章纳入荟萃分析。PORT评分和CURB-65分别在7项和8项研究中进行了评估。使用PORT评分≥IV和V的截断值时，诊断比值比（DOR）分别为5.28（2.49 - 11.17）和3.76（2.88 - 4.92），曲线下面积（AUC）分别为0.68（0.64 - 0.72）和0.71（0.67 - 0.75）。相反，仅应用于非免疫功能低下患者时，≥IV和V的AUC分别为0.71（0.67 - 0.76）和0.74（0.70 - 0.78）。相比之下，使用CURB-65≥2和≥3的截断值时，DOR分别为3.35（2.26 - 4.97）和2.65（2.05 - 3.43），AUC分别为0.65（0.61 - 0.69）和0.66（0.62 - 0.70）。相反，仅应用于非免疫功能低下患者时，≥2和≥3的AUC分别为0.65（0.61 - 0.69）和0.68（0.64 - 0.72）。
与CAP患者的工具相比，PORT评分和CURB-65的预测能力不强，尽管PORT评分在预测HCAP患者死亡率方面比CURB-65更有用。然而，根据我们的结果，这些工具，尤其是PORT评分，在仅限于非免疫功能低下患者时可能更有用。
