Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep 11;9(9):1202.
doi: 10.3390/healthcare9091202.

Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis

Sarah Khalid Al Hussain  1   2 , Amanj Kurdi  1   3   4 , Nouf Abutheraa  1   5 , Asma AlDawsari  1   6 , Jacqueline Sneddon  7 , Brian Godman  1   4   8 , Ronald Andrew Seaton  7   9   10
Affiliations
Review

Validity of Pneumonia Severity Assessment Scores in Africa and South Asia: A Systematic Review and Meta-Analysis

Sarah Khalid Al Hussain et al. Healthcare (Basel). .

Abstract

Background: 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).

Methods: 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.

Results: 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).

Conclusions: 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).

Keywords: community-acquired pneumonia; developing countries; meta-analysis; mortality; prognosis; severity of illness index; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the study selection process.
Figure 2
Figure 2
Forest plots of the association between CURB-65 and CRB-65 at the studied cut-offs and mortality prediction in patients with community-acquired pneumonia.
Figure 3
Figure 3
Forest plots for the sensitivity and specificity of CURB-65 and CRB-65 at the studied cut-offs for mortality prediction.
Figure 4
Figure 4
Forest plots for the positive and negative likelihood ratio of CURB-65 and CRB-65 at the studied cut-offs for mortality prediction.
Figure 5
Figure 5
Area under the receiver operating characteristic (AUROC) curves for the included studies examining CURB-65 and CRB-65 at the studied cut-offs for mortality prediction. The numbers in the circle refer to the included studies.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Troeger C., Forouzanfar M., Rao P.C., Khalil I., Brown A., Swartz S., Fullman N., Mosser J., Thompson R.L., Reiner R.C., et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: A systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect. Dis. 2017;17:1133–1161. doi: 10.1016/S1473-3099(17)30396-1. - DOI - PMC - PubMed
    1. Zar H.J., Madhi S.A., Aston S.J., Gordon S.B. Pneumonia in low and middle income countries: Progress and challenges. Thorax. 2013;68:1052–1056. doi: 10.1136/thoraxjnl-2013-204247. - DOI - PMC - PubMed
    1. Troeger C., Blacker B., Khalil I.A., Rao P.C., Cao J., Zimsen S.R.M., Albertson S.B., Deshpande A., Farag T., Abebe Z., et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect. Dis. 2018;18:1191–1210. doi: 10.1016/S1473-3099(18)30310-4. - DOI - PMC - PubMed
    1. Vos T., Allen C., Arora M., Barber R.M., Bhutta Z.A., Brown A., Carter A., Casey D.C., Charlson F.J., Chen A.Z., et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 Diseases and Injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789–1858. - PMC - PubMed
    1. Torres A., Peetermans W.E., Viegi G., Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: A literature review. Thorax. 2013;68:1057–1065. doi: 10.1136/thoraxjnl-2013-204282. - DOI - PMC - PubMed

LinkOut - more resources