CRB-65 评分的校准、判别和分层似然比的荟萃分析。
Meta-analysis of Calibration, Discrimination, and Stratum-Specific Likelihood Ratios for the CRB-65 Score.
机构信息
Department of Epidemiology and Biostatistics, College of Public Health , University of Georgia, Athens, GA, USA.
HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.
出版信息
J Gen Intern Med. 2019 Jul;34(7):1304-1313. doi: 10.1007/s11606-019-04869-z. Epub 2019 Apr 16.
BACKGROUND
The CRB-65 score is recommended as a decision support tool to help identify patients with community-acquired pneumonia (CAP) who can safely be treated as outpatients.
OBJECTIVE
To perform an updated meta-analysis of the accuracy, discrimination, and calibration of the CRB-65 score using a novel approach to calculation of stratum-specific likelihood ratios.
DESIGN
Meta-analysis of accuracy, discrimination, and calibration.
METHODS
We searched PubMed, Google, previous systematic reviews, and reference lists of included studies. Data was abstracted and quality assessed in parallel by two investigators. The quality assessment used an adaptation of the TRIPOD and PROBAST criteria. Measures of discrimination, calibration, and stratum-specific likelihood ratios are reported.
KEY RESULTS
Twenty-nine studies met our inclusion criteria and provided usable data. Most studies were set in Europe, none in North America, and 12 were judged to be at low risk of bias. The pooled estimate of area under the receiver operating characteristic curve was 0.74 (95% CI 0.71-0.77) for all studies. Calibration was good although there was significant heterogeneity; the pooled estimate of the ratio of observed to expected mortality for all studies was 1.04 (95% CI 0.91-1.19). The corresponding values for studies at low risk of bias where patients could be treated as outpatients or inpatients were 0.76 (0.70-0.81) and 0.88 (0.69-1.13). Summary estimates of stratum-specific likelihood ratios for all studies were 0.19 for the low-risk group, 1.1 for the moderate-risk group, and 4.5 for the high-risk group, and 0.13, 1.3, and 5.6 for studies at low risk of bias where patients could be treated as outpatients or inpatients.
CONCLUSIONS
The CRB-65 is useful for identifying low-risk patients for outpatient therapy. Given a 4% overall mortality risk, patients classified as low risk by the CRB-65 had an outpatient mortality risk of no more than 0.5%.
背景
CRB-65 评分被推荐作为一种决策支持工具，用于帮助识别可以安全门诊治疗的社区获得性肺炎（CAP）患者。
目的
使用一种新的方法计算分层特异性似然比，对 CRB-65 评分的准确性、区分度和校准度进行更新的荟萃分析。
设计
准确性、区分度和校准度的荟萃分析。
方法
我们搜索了 PubMed、Google、以前的系统评价和纳入研究的参考文献列表。两名研究者同时提取数据并进行质量评估。质量评估使用了 TRIPOD 和 PROBAST 标准的改编版。报告了区分度、校准度和分层特异性似然比的测量值。
主要结果
29 项研究符合我们的纳入标准并提供了可用数据。大多数研究都在欧洲进行，没有在北美进行，其中 12 项被认为是低偏倚风险的。所有研究的汇总接受者操作特征曲线下面积估计值为 0.74（95%CI 0.71-0.77）。尽管存在显著的异质性，但校准效果良好；所有研究的观察到的与预期死亡率之比的汇总估计值为 1.04（95%CI 0.91-1.19）。低偏倚风险研究中，可将患者作为门诊或住院患者进行治疗的患者的相应值为 0.76（0.70-0.81）和 0.88（0.69-1.13）。所有研究的分层特异性似然比汇总估计值分别为低危组 0.19、中危组 1.1 和高危组 4.5，低危组可作为门诊或住院患者进行治疗的研究中分别为 0.13、1.3 和 5.6。
结论
CRB-65 可用于识别门诊治疗的低危患者。在总死亡率为 4%的情况下，CRB-65 分类为低危的患者门诊死亡率不超过 0.5%。
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