Prediction of severe community-acquired pneumonia a systematic review and meta-analysis 英文参考文献.docVIP

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Prediction of severe community-acquired pneumonia a systematic review and meta-analysis 英文参考文献.doc

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Prediction of severe community-acquired pneumonia a systematic review and meta-analysis 英文参考文献

Martietal.CriticalCare2012,16:R141 /content/16/4/R141 RESEARCH OpenAccess Predictionofseverecommunity-acquired pneumonia:asystematicreviewandmeta-analysis ChristopheMarti1*,NicolasGarin1,2,OlivierGrosgurin1,AntoinePoncet3,ChristopheCombescure3, SebastianCarballo1andArnaudPerrier1 Abstract Introduction:Severityassessmentandsite-of-caredecisionsforpatientswithcommunity-acquiredpneumonia (CAP)arepivotalforpatients’safetyandadequateallocationofresources.Lateadmissiontotheintensivecareunit (ICU)hasbeenassociatedwithincreasedmortalityinCAP.Weaimedtoreviewandmeta-analyzesystematically theperformanceofclinicalpredictionrulestoidentifyCAPpatientsrequiringICUadmissionorintensivetreatment. Methods:WesystematicallysearchedMedline,Embase,andtheCochraneControlledTrialsregistryforclinicaltrials evaluatingtheperformanceofprognosticrulestopredicttheneedforICUadmission,intensivetreatment,orthe occurrenceofearlymortalityinpatientswithCAP. Results:Sufficientdatawereavailabletoperformameta-analysisoneightscores:PSI,CURB-65,CRB-65,CURB,ATS 2001,ATS/IDSA2007,SCAPscore,andSMART-COP.TheestimatedAUCofPSIandCURB-65scorestopredictICU admissionwas0.69.AmongscoresproposedforpredictionofICUadmission,ATS-2001andATS/IDSA2007scores hadbetteroperativecharacteristics,withasensitivityof70%(CI,61to77)and84%(48to97)andaspecificityof 90%(CI,82to95)and78%(46to93),buttheirclinicalutilityislimitedbytheuseofmajorcriteria. ATS/IDSA2007minorcriteriahavegoodspecificity(91%CI,84to95)andmoderatesensitivity(57%CI,46to68). SMART-COPandSCAPscorehavegoodsensitivity(79%CI,69to97,and94%CI,88to97)andmoderate specificity(64%CI,30to66,and46%CI,27to66).Majordifferencesinpopulations,prognosticfactor measurement,andoutcomedefinitionlimitcomparison.Ouranalysisalsohighlightsahighdegreeof heterogeneityamongthestudies. Conclusions:NewseverityscoresforpredictingtheneedforICUorintensivetreatmentinpatientswithCAP,such asATS/IDSA2007minorcriteria,SCAPscore,andSMART-COP,havebetterdiscriminativeperformancescompared withPSIandCURB-65.