【摘要】 目的 :通过分析已有的临床数据,观察多个评估系统对社区获得性肺炎(community acquired pneumonia,CAP)患者30 d的死亡风险和ICU入住风险的预测价值。方法:用关键词途径对2004年至2015年的Pub Med和EMBASE数据库进行文献检索,并对符合条件的所有研究进行荟萃分析。结果:共纳入文献48篇,共51 639例CAP患者采用各评价系统对其30 d死亡风险进行评估,共评估了10 590例CAP患者入住ICU的风险。通过汇总计算得出,对于30 d死亡风险的预测,CRB-65(confusion,respiratory,age 65 years)评分系统的灵敏度为98%,特异度为33%,综合受试者工作特征(summary receiver operating characteristic,s ROC)曲线下面积为0.56;英国胸科协会改良肺炎评分(confusion,uremia,respiratory,blood pressure,age 65 years,CURB-65评分)系统的灵敏度为84%,特异度为55%,s ROC曲线下面积为0.78;肺炎严重度指数(pneumonia severity index,PSI)系统的灵敏度为90%,特异度为57%,s ROC曲线下面积为0.88;以符合2007美国感染病学会(Infectious Diseases Society of America,IDSA)/美国胸科学会(American Thoracic Society,ATS)3项以上次要标准且不符合主要标准的评估灵敏度为76%,特异度为90%,s ROC曲线下面积为0.89;采用SMART-COP评估的灵敏度为77%,特异度为65%,s ROC曲线下面积为0.67。对于入住ICU风险,采用CURB-65系统评估的灵敏度为52%,特异度为77%,s ROC曲线下面积为0.67;采用PSI系统评估的灵敏度为70%,特异度为61%,s ROC曲线下面积为0.69;采用SMART-COP评分评估的灵敏度为84%,特异度为70%,s ROC曲线下面积为0.74。结论 :PSI、CURB-65评分系统对患者30 d死亡风险的预测价值较大,可作为住院标准的重要参考。对于收住ICU的风险评估,SMART-COP的预测价值相对较大,而PSI、CURB-65评分价值相对较低。更多还原

【Abstract】 Objective: To review and analyze the value of various severity scale system for predicting 30 day mortality and ICU admission in community acquired pneumonia(CAP) patients via meta-analysis. Methods: MEDLINE and EMBASE(2004-2015) were retrieved and 48 papers were collected. Altogether 51 639 CAP patients were enrolled for pre-dicting 30 day mortality, and 10 590 CAP patients were enrolled for predicting ICU admission. The values of five severity scale system: CRB-65, CURB-65, PSI, 2007 IDSA/ATS, SMART-COP for predicting 30 day mortality and ICU admission were meta-analyzed. Results: For predicting 30 day mortality, CRB-65 had a sensitivity of 98%; specificity of 33% and area under summary receiver operator characteristic(s ROC) curve(AUC) 0.56. For CURB-65, the above mentioned indices were 84%, 55% and 0.78, respectively. PSI(pneumonia severity index) had a sensitivity of 90%, specificity of 57% and area under s ROC curve 0.88; the above mentioned indices for 2007 IDSA/ATS were 76%, 90% and 0.89, respectively. For predicting ICU admission. CURB-65 had a sensitivity of 52%, specificity of 77% and area under s ROC 0.67; the above mentioned indices for PSI were 70%, 61%and 0.69, respectively. The SMART-COP had a sensitivity of 84%, specificity of70%, and area under s ROC curve 0.74. Conclusions: PSI, CURB-65 could be used as important references for predicting30 day mortality in patients with CAP. For ICU admission, the prediction value of SMART-COP is relatively better than PSI and CURB-65 scale systems.更多还原