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).
Highlights
Community-acquired pneumonia (CAP) is considered the leading cause of global deaths due to infectious diseases in all age groups, in low- and middle-income countries (LMICs) [1]
The following combinations of search terms were used for Scopus: ((“Community-acquired pneumonia” OR “Bronchopneumoni*” OR “Pneumoni*” OR “Acute respiratory infection*” OR “acute respiratory illness” OR “lower respiratory tract infection*” OR “lower respiratory infection*”) AND (“low-middle-income countr*” OR “LMIC*” OR “low-income countr*” OR “less developed countr*” OR “middle-income countr*” OR “Malawi” OR “Kenya” OR “Tanzania” OR “Africa” OR “South Africa” OR “Developing countr*”) AND (“Prognos*” OR “Score*” OR “Tool*” OR “severity assessment” OR “risk assessment” OR “Predict*” OR “Mortality score*” OR “Severity score*” OR “Pneumonia Severity Index (PSI)” OR “CURB-65” OR “CURB65” OR “CRB65” OR “CRB-65” OR “SOAR” OR “SCAP” OR “PIRO” OR “RISC” OR “mRISC” OR “Pneumonia severity index” OR “I-DROP”))
Titles and abstracts of 9900 records were screened against the inclusion criteria after deduplication; only 31 studies were considered for full-text screening
Summary
Community-acquired pneumonia (CAP) is considered the leading cause of global deaths due to infectious diseases in all age groups, in low- and middle-income countries (LMICs) [1]. Reflecting the pneumococcal vaccination programme, death from LRTIs in children under five years of age has declined between 2007 and 2017 by more than 36% Mortality in those aged 70 years and older has risen by 33.6% [4]. Community-acquired pneumonia (CAP) severity assessment scores are widely used, their validity in low- and middle-income countries (LMICs) is not well defined. 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. There is a lack of robust evidence regarding other scores, including the Pneumonia Severity Index (PSI)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
