Department of Geriatrics, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang Province, P.R. China.
Department of Neurosurgery, Zhuji People's Hospital of Zhejiang Province, Shaoxing Zhejiang Province, P.R. China.
Expert Rev Respir Med. 2021 Nov;15(11):1461-1472. doi: 10.1080/17476348.2021.1923482. Epub 2021 May 27.
: Different scoring systems (A2DS2, AISAPS, ISAN) have been designed to predict the risk of in-hospital stroke-associated pneumonia (SAP). Studies have assessed the accuracy of these scores for predicting SAP. We performed this meta-analysis to consolidate the evidence on the predictive accuracies for SAP of the A2DS2, AISAPS, and ISAN scores.: We conducted a systematic search for all studies reporting the SAP predictive accuracy of A2DS2, AISAPS, or ISAN scores in the databases of PubMed Central, SCOPUS, MEDLINE, Embase, and Cochrane from inception until December 2020. We used the STATA software for the meta-analysis.: We included 19 studies with 35 849 patients. The pooled score sensitivities were 78% (95% CI, 71%-83%) for A2DS2, 79% (95% CI, 77%-81%) for AISAPS, and 79% (95% CI, 77%-81%) for ISAN. The pooled score specificities were 73% (95% CI, 65%-80%) for A2DS2, 74% (95% CI, 69%-79%) for AISAPS, and 74% (95% CI, 69%-79%) for ISAN. We found significant heterogeneity for all the scoring systems based on the chi-square test results and an statistic > 75%. We performed meta-regression to explore the source of heterogeneity and found that patient selection (< 0.05) and reference standards (< 0.05) in the sensitivity model, index test standards (< 0.05), flow and timing of tests (< 0.01) in the specificity model, and mean age (p < 0.001) in the joint model were the source of heterogeneity.: To summarize, we found that A2S2, AISAPS and ISAN have moderate predictive accuracy for SAP with A2S2 having a stable cutoff value.
: 不同的评分系统（A2DS2、AISAPS、ISAN）已被设计用于预测院内卒中相关性肺炎（SAP）的风险。已有研究评估了这些评分系统预测 SAP 的准确性。我们进行了这项荟萃分析，以综合评估 A2DS2、AISAPS 和 ISAN 评分预测 SAP 的预测准确性的证据。
: 我们系统地检索了从开始到 2020 年 12 月在 PubMed Central、SCOPUS、MEDLINE、Embase 和 Cochrane 数据库中报告 A2DS2、AISAPS 或 ISAN 评分预测 SAP 准确性的所有研究。我们使用 STATA 软件进行荟萃分析。
: 我们纳入了 19 项研究，共 35849 名患者。A2DS2 的汇总评分敏感性为 78%（95%CI，71%-83%），AISAPS 为 79%（95%CI，77%-81%），ISAN 为 79%（95%CI，77%-81%）。A2DS2 的汇总评分特异性为 73%（95%CI，65%-80%），AISAPS 为 74%（95%CI，69%-79%），ISAN 为 74%（95%CI，69%-79%）。根据卡方检验结果和 I 方统计量>75%，我们发现所有评分系统均存在显著异质性。我们进行了荟萃回归分析以探讨异质性的来源，发现敏感性模型中的患者选择（<0.05）和参考标准（<0.05）、特异性模型中的索引测试标准（<0.05）、测试的流程和时间（<0.01）以及联合模型中的平均年龄（p<0.001）是异质性的来源。
: 总之，我们发现 A2S2、AISAPS 和 ISAN 对 SAP 具有中等预测准确性，且 A2S2 具有稳定的截断值。
