prediction of severe community-acquired pneumonia a systematic review and meta-analysis预测社区获得性肺炎严重的系统回顾和荟萃分析.pdfVIP

Marti et al. Critical Care 2012, 16:R141 /content/16/4/R141 RESEARCH Open Access Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis 1* 1,2 1 3 3 Christophe Marti , Nicolas Garin , Olivier Grosgurin , Antoine Poncet , Christophe Combescure , Sebastian Carballo1 and Arnaud Perrier1 Abstract Introduction: Severity assessment and site-of-care decisions for patients with community-acquired pneumonia (CAP) are pivotal for patients’ safety and adequate allocation of resources. Late admission to the intensive care unit (ICU) has been associated with increased mortality in CAP. We aimed to review and meta-analyze systematically the performance of clinical prediction rules to identify CAP patients requiring ICU admission or intensive treatment. Methods: We systematically searched Medline, Embase, and the Cochrane Controlled Trials registry for clinical trials evaluating the performance of prognostic rules to predict the need for ICU admission, intensive treatment, or the occurrence of early mortality in patients with CAP. Results: Sufficient data were available to perform a meta-analysis on eight scores: PSI, CURB-65, CRB-65, CURB, ATS 2001, ATS/IDSA 2007, SCAP score, and SMART-COP. The estimated AUC of PSI and CURB-65 scores to predict ICU admission was 0.69. Among scores proposed for prediction of ICU admission, ATS-2001 and ATS/IDSA 2007 scores had better operative characteristics, with a sensitivity of 70% (CI, 61 to 77) and 84% (48 to 97) and a specificity of 90% (CI, 82 to 95) and 78% (46 to 93), but their clinical utility is limited by the use of major criteria. ATS/IDSA 2007 minor criteria have good specificity (91% CI, 84 to 95) and moderate sensitivity (5