医疗相关性肺炎(HCAP)患者的死亡率需要准确的预后工具,以提供适当的医疗服务。但是PSI等工具对死亡率预测的功效,A-DROP,I-Road,和CURB-65,广泛用于预测社区获得性肺炎和医院获得性肺炎病例的死亡率,仍然有争议。在这项研究中,我们使用PubMed进行了系统评价和荟萃分析,Cochrane图书馆(试验),和Ichushi网络数据库(2022年8月22日访问)。我们确定了评估PSI的文章,A-DROP,I-Road,或CURB-65和HCAP患者的死亡率结果,并计算了合并的敏感度,特殊性,正似然比(PLR),负似然比(NLR),诊断优势比(DOR),和用于死亡率预测的曲线下面积(AUC)。此外,这4种评估工具在预测预后方面的差异采用纳入研究报告的AUC值汇总的总体AUC进行评估.最终,纳入21篇文章,这些质量评估由QUADAS-2进行评估。在HCAP患者中使用中度的临界值,合并灵敏度的范围,特异性,PLR,NLR,和DOR分别为0.91-0.97、0.15-0.44、1.14-1.66、0.18-0.33和3.86-9.32。在这些患者中使用严重的临界值时,合并灵敏度的范围,特异性,PLR,NLR,和DOR分别为0.63-0.70、0.54-0.66、1.50-2.03、0.47-0.58和2.66-4.32。总体AUC为0.70(0.68-0.72),0.70(0.63-0.76),0.68(0.64-0.73),和0.67(0.63-0.71),分别,对于PSI,A-DROP,I-Road,和CURB-65(p=0.66)。总之,这些严重程度评估工具没有足够的能力来预测HCAP患者的死亡率.此外,这四种严重性评估工具在预测性能上没有显著差异.
Accurate prognostic tools for mortality in patients with healthcare-associated pneumonia (HCAP) are needed to provide appropriate medical care, but the efficacy for mortality prediction of tools like PSI, A-DROP, I-ROAD, and CURB-65, widely used for predicting mortality in community-acquired and hospital-acquired pneumonia cases, remains controversial. In this study, we conducted a systematic review and meta-analysis using PubMed, Cochrane Library (trials), and Ichushi web database (accessed on August 22, 2022). We identified articles evaluating either PSI, A-DROP, I-ROAD, or CURB-65 and the mortality outcome in patients with HCAP, and calculated the pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the summary area under the curves (AUCs) for mortality prediction. Additionally, the differences in predicting prognosis among these four assessment tools were evaluated using overall AUCs pooled from AUC values reported in included studies. Eventually, 21 articles were included and these quality assessments were evaluated by QUADAS-2. Using a cut-off value of moderate in patients with HCAP, the range of pooled sensitivity, specificity, PLR, NLR, and DOR were found to be 0.91-0.97, 0.15-0.44, 1.14-1.66, 0.18-0.33, and 3.86-9.32, respectively. Upon using a cut-off value of severe in those patients, the range of pooled sensitivity, specificity, PLR, NLR, and DOR were 0.63-0.70, 0.54-0.66, 1.50-2.03, 0.47-0.58, and 2.66-4.32, respectively. Overall AUCs were 0.70 (0.68-0.72), 0.70 (0.63-0.76), 0.68 (0.64-0.73), and 0.67 (0.63-0.71), respectively, for PSI, A-DROP, I-ROAD, and CURB-65 (p = 0.66). In conclusion, these severity assessment tools do not have enough ability to predict mortality in HCAP patients. Furthermore, there are no significant differences in predictive performance among these four severity assessment tools.