Al Hussain Sarah Khalid, Kurdi Amanj, Abutheraa Nouf, AlDawsari Asma, Sneddon Jacqueline, Godman Brian, Seaton Ronald Andrew
Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Hofuf 31982, Saudi Arabia.
Healthcare (Basel). 2021 Sep 11;9(9):1202. doi: 10.3390/healthcare9091202.
Although community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. We aimed to investigate the validity and performance of the existing scores among adults in LMICs (Africa and South Asia).
Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus and Web of Science were searched to 21 May 2020. Studies evaluating a pneumonia severity score/tool among adults in these countries were included. A bivariate random-effects meta-analysis was performed to examine the scores' performance in predicting mortality.
Of 9900 records, 11 studies were eligible, covering 12 tools. Only CURB-65 (Confusion, Urea, Respiratory Rate, Blood Pressure, Age ≥ 65 years) and CRB-65 (Confusion, Respiratory Rate, Blood Pressure, Age ≥ 65 years) were included in the meta-analysis. Both scores were effective in predicting mortality risk. Performance characteristics (with 95% Confidence Interval (CI)) at high (CURB-65 ≥ 3, CRB-65 ≥ 3) and intermediate-risk (CURB-65 ≥ 2, CRB-65 ≥ 1) cut-offs were as follows: pooled sensitivity, for CURB-65, 0.70 (95% CI = 0.25-0.94) and 0.96 (95% CI = 0.49-1.00), and for CRB-65, 0.09 (95% CI = 0.01-0.48) and 0.93 (95% CI = 0.50-0.99); pooled specificity, for CURB-65, 0.90 (95% CI = 0.73-0.96) and 0.64 (95% CI = 0.45-0.79), and for CRB-65, 0.99 (95% CI = 0.95-1.00) and 0.43 (95% CI = 0.24-0.64).
CURB-65 and CRB-65 appear to be valid for predicting mortality in LMICs. CRB-65 may be employed where urea levels are unavailable. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI).
尽管社区获得性肺炎（CAP）严重程度评估评分被广泛应用，但其在低收入和中等收入国家（LMICs）的有效性尚未明确界定。我们旨在调查现有评分在LMICs（非洲和南亚）成年人中的有效性和性能。
检索了截至2020年5月21日的Medline、Embase、Cochrane对照试验中心注册库、Scopus和科学网。纳入评估这些国家成年人肺炎严重程度评分/工具的研究。进行双变量随机效应荟萃分析以检验评分在预测死亡率方面的性能。
在9900条记录中，11项研究符合条件，涵盖12种工具。荟萃分析仅纳入了CURB-65（意识模糊、尿素、呼吸频率、血压、年龄≥65岁）和CRB-65（意识模糊、呼吸频率、血压、年龄≥65岁）。两种评分在预测死亡风险方面均有效。高风险（CURB-65≥3，CRB-65≥3）和中度风险（CURB-65≥2，CRB-65≥1）临界值时的性能特征（95%置信区间（CI））如下：CURB-65的合并敏感度分别为0.70（95%CI = 0.25 - 0.94）和0.96（95%CI = 0.49 - 1.00），CRB-65的合并敏感度分别为0.09（95%CI = 0.01 - 0.48）和0.93（95%CI = 0.50 - 0.99）；CURB-65的合并特异度分别为0.90（95%CI = 0.73 - 0.96）和0.64（95%CI = 0.45 - 0.79），CRB-65的合并特异度分别为0.99（95%CI = 0.95 - 1.00）和0.43（95%CI = 0.24 - 0.64）。
CURB-65和CRB-65在LMICs中似乎对预测死亡率有效。在无法获取尿素水平时可采用CRB-65。关于其他评分，包括肺炎严重程度指数（PSI），缺乏有力证据。
