A2DS2评分诊断中国缺血性脑卒中相关性肺炎准确性的Meta分析

目的评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性及临床适应性。方法通过检索Medline、PubMed、Embase、Cochrane、Web of Science、万方、中国知网、维普、中国生物医学数据库自建库至2020年2月发表的文献,筛选应用A2DS2评分预测中国缺血性脑卒中患者发生肺炎的相关文献,采用QUADAS-2风险评估标准对纳入文献进行质量评价,采用Meta分析评价A2DS2评分诊断中国缺血性脑卒中相关性肺炎患者的准确性,采用Deek检验评价文献发表偏倚,采用范根图评价A2DS2评分的临床适用性。结果最终纳入12篇文献,共7719例患者。Meta分析显示A2DS2评分的诊断比值比(DOR)为18(95%CI:12~27),合并灵敏度为0.76(95%CI:0.68~0.82),合并特异度为0.85(95%CI:0.80~0.88),合并阳性似然比为5.02(95%CI:3.91~6.44),合并阴性似然比为0.29(95%CI:0.22~0.38)。A2DS2评分诊断中国缺血性脑卒中相关性肺炎的综合受试者工作特征(SROC)曲线的曲线下面积(AUC)为0.88(95%CI:0.85~0.91)。Deek检验结果显示各纳入文献无明显发表偏倚(P>0.05)。范根图显示A2DS2评分的临床适用性较好。结论A2DS2评分对中国缺血性脑卒中相关性肺炎具有较好的诊断价值,可用于临床初步筛查缺血性脑卒中相关性肺炎患者。

Accuracy of A2DS2 scale in diagnosis of ischemic stroke-associated pneumonia in China: a Meta-analysis

Objective To comprehensively verify the diagnostic accuracy and clinical adaptability of A2DS2 scale in predicting the occurrence of stroke-associated pneumonia in China using Meta-analysis.Methods Relevant literature about stroke-associated pneumonia in China were selected from Medline,PubMed,Embase,Cochrane Library,Web of Science,Wanfang Data Knowledge Service Platform,VIP Paper Check System,and China National Knowledge Infrastructure(CNKI),and China Biological Database from database construction to February 2020.Tool for Quality Assessment of Diagnostic Accuracy Studies(QUADAS-2)was used to evaluate the quality of the literature.Deek funnel plot was used to evaluate literature publication bias.Fagen plot was used to evaluate the clinical applicability of A2DS2 scale.Results Twelve articles were finally included with a total of 7719 patients.Bivariate mixed effects analysis was used to obtain results with diagnostic odds ratio(DOR)of 18(95%CI=12-27),pooled sensitivity of 0.76(95%CI=0.68-0.82),pooled specificity of 0.85(95%CI=0.80-0.88),pooled positive likelihood ratio of 5.02(95%CI=3.91-6.44),pooled negative likelihood ratio of 0.29(95%CI=0.22-0.38),and integrated area under the receiver operating curve(AUC)of 0.88(95%CI=0.85-0.91).Combined with the funnel plot results,there was no significant publication bias in the overall study(P=0.07);and the paradigm plot showed that when the A2DS2 diagnosis was positive,the probability of subjects being diagnosed with stroke-associated pneumonia increased to 83%,suggesting that A2DS2 scale had good applicability and high clinical diagnostic value.Conclusion A2DS2 scale has good predictive value in stroke-associated pneumonia in Chinese and can be used for clinical preliminary screening of patients with stroke-associated pneumonia.