North China University of Science and Technology, Tangshan, Hebei, China.
Department of Neurology, Hebei General Hospital, 050000, Shijiazhuang, Hebei, China.
BMC Neurol. 2021 Jan 22;21(1):33. doi: 10.1186/s12883-021-02060-8.
This review aims to evaluate the performance and clinical applicability of the A2DS2 scale via systematic review and meta-analysis.
The Medline, Embase, Cochrane Library, CBM, CNKI, and Wanfang databases were searched. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Funnel plots and Egger's test were used to evaluate publication bias. The bivariate random-effect model was used for calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC). A Fagan nomogram was applied to evaluate the clinical applicability of the A2DS2 scale.
A total of 29 full-text articles met the inclusion criteria, including 19,056 patients. Bivariate mixed-effects regression models yielded a mean sensitivity of 0.78 (95 % CI: 0.73-0.83), a specificity of 0.79 (95 % CI: 0.73-0.84), a positive likelihood ratio of 3.7 (95 % CI: 2.9-4.6), and a negative likelihood ratio of 0.27 (95 % CI: 0.23-0.33). The area under the receiver operating characteristic curve was 0.85 (95 % CI: 0.82-0.88). If given a pre-test probability of 50 %, the Fagan nomogram showed that when A2DS2 was positive, the post-test probability improved to 79 %. In contrast, when A2DS2 was negative, it decreased to 22 %. The results of the subgroup analysis showed no effect on the diagnostic accuracy of the A2DS2 scale in predicting stroke-associated pneumonia, except for the optimal cut-off value.
The A2DS2 scale demonstrates high clinical applicability and could be a valid scale for the early prediction of stroke-associated pneumonia in stroke patients.
本综述旨在通过系统评价和荟萃分析评估 A2DS2 量表的性能和临床适用性。
检索 Medline、Embase、Cochrane 图书馆、CBM、CNKI 和万方数据库。使用诊断准确性研究的质量评估工具（QUADAS-2）评估偏倚风险。使用漏斗图和 Egger 检验评估发表偏倚。使用双变量随机效应模型计算敏感度、特异度、阳性似然比、阴性似然比、诊断优势比和曲线下面积（AUC）。应用 Fagan 列线图评估 A2DS2 量表的临床适用性。
共有 29 篇全文文章符合纳入标准，包括 19056 名患者。双变量混合效应回归模型得出的平均敏感度为 0.78（95 % CI：0.73-0.83），特异度为 0.79（95 % CI：0.73-0.84），阳性似然比为 3.7（95 % CI：2.9-4.6），阴性似然比为 0.27（95 % CI：0.23-0.33）。受试者工作特征曲线下面积为 0.85（95 % CI：0.82-0.88）。如果预测试验概率为 50 %，Fagan 列线图显示，当 A2DS2 为阳性时，后测试概率提高到 79 %。相反，当 A2DS2 为阴性时，概率降低到 22 %。亚组分析结果表明，除了最佳截断值外，A2DS2 量表对预测脑卒中相关性肺炎的诊断准确性没有影响。
A2DS2 量表具有较高的临床适用性，可作为脑卒中患者脑卒中相关性肺炎早期预测的有效量表。
