Port Elizabeth Hospital Complex, Port Elizabeth, South Africa.
Livingstone Tertiary Hospital, Stanford Road, Port Elizabeth, South Africa.
Syst Rev. 2021 Jul 27;10(1):211. doi: 10.1186/s13643-021-01767-6.
Chronic obstructive pulmonary disease (COPD) is a major cause of years of life lost globally. Acute exacerbations of COPD (AECOPD) drive disease progression, reduce quality of life and are a source of mortality in COPD. Approximately 50% of AECOPD are due to bacterial infections. Diagnosing bacterial infection as the aetiology of AECOPD however remains challenging as investigations are limited by practicality, accuracy and expense. Clinicians have traditionally used sputum colour as a marker of bacterial infection in AECOPD, despite the lack of high-quality evidence for this practice. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy of sputum colour in the diagnosis of bacterial causes of AECOPD.
Articles will be searched for in electronic databases (MEDLINE, Google Scholar Scopus, Web of Science, Africa-Wide, CINAHL and Health Source Nursing Academy) and we will conduct a review of citation indexes and the grey literature. Two reviewers will independently conduct study selection, against pre-defined eligibility criteria, data extraction and quality assessment of included articles using the QUADAS-2 tool. We will perform a meta-analysis using a bivariate logistic regression model with random effects. We will explore heterogeneity through the visual examination of the forest plots of sensitivities and specificities and through the inclusion of possible sources of heterogeneity as covariates in a meta-regression model if sufficient studies are included in the analysis. We also perform a sensitivity analysis to explore the effect of study quality on our findings. The results of this review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and will be submitted for peer-review and publication.
The findings of this review will assist clinicians in diagnosing the aetiology of AECOPD and may have important implications for decision making in resource-limited settings, as well as for antimicrobial stewardship.
PROSPERO CRD42019141498.
慢性阻塞性肺疾病（COPD）是全球范围内导致多年生命损失的主要原因。COPD 的急性加重（AECOPD）会导致疾病进展、降低生活质量，并且是 COPD 患者死亡的一个原因。大约 50%的 AECOPD 是由细菌感染引起的。然而，由于检查受到实用性、准确性和费用的限制，诊断 AECOPD 中细菌感染的病因仍然具有挑战性。临床医生传统上使用痰液颜色作为 AECOPD 中细菌感染的标志物，尽管这种做法缺乏高质量的证据。本系统评价和荟萃分析的目的是确定痰液颜色在诊断 AECOPD 中细菌病因方面的诊断准确性。
将在电子数据库（MEDLINE、Google Scholar Scopus、Web of Science、Africa-Wide、CINAHL 和 Health Source Nursing Academy）中搜索文章，并对引文索引和灰色文献进行综述。两名审查员将根据预先确定的纳入标准，独立进行研究选择、数据提取和纳入文章的质量评估，使用 QUADAS-2 工具。我们将使用二元逻辑回归模型进行荟萃分析，采用随机效应。如果分析中包含足够的研究，我们将通过视觉检查敏感性和特异性的森林图以及将可能的异源因素作为协变量纳入荟萃回归模型来探索异质性。我们还进行敏感性分析，以探讨研究质量对我们发现的影响。本综述的结果将按照系统评价和荟萃分析的首选报告项目进行报告，并将提交同行评审和发表。
本综述的结果将有助于临床医生诊断 AECOPD 的病因，并可能对资源有限环境中的决策制定以及抗菌药物管理产生重要影响。
PROSPERO CRD42019141498。
