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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.

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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

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