Precisión diagnóstica de las escalas para el tamizaje de la depresión en pacientes con insuficiencia cardíaca: revisión sistemática y meta-análisis
Diagnostic accuracy of scales for depression screening in patients with heart failure: systematic review and meta-analysis
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Introducción: a pesar de la existencia de recomendaciones para el cribado de síntomas depresivos en pacientes con enfermedad cardiovascular e insuficiencia cardiaca (IC), no existen datos comparativos sobre el rendimiento de las escalas psicométricas utilizadas en pacientes con IC. Este estudio compara el rendimiento psicométrico de las escalas de cribado utilizadas para los síntomas depresivos en dichos pacientesprotocols, the prevalence of febrile neutropenia in these patients has increased. Métodos: para la revisión sistemática se utilizaron las recomendaciones de la declaración PRISMA. Para la búsqueda se utilizaron MEDLINE, EMBASE, Psychology and Behavioral Sciences Collection, SCOPUS, Lilacs, Australasian Medical Index y el African Index desde enero de 2000 hasta febrero de 2016. Los artículos elegibles se publicaron en cualquier idioma y evaluaron las propiedades psicométricas de las escalas de cribado de síntomas depresivos en pacientes con IC. Se utilizaron los criterios QUADAS-2 para la evaluación de la calidad, y un meta-análisis desarrollado a través de un modelo jerárquico obtuvo las estimaciones agrupadas para la sensibilidad, la especificidad, la razón de verosimilitud, los valores predictivos y la razón de probabilidades de diagnóstico (DOR) con intervalos de confianza del 95%. Resultados: la búsqueda inicial identificó 1238 citas; sólo tres reunían los criterios de inclusión para la evaluación cuantitativa. La sensibilidad y especificidad combinadas fueron del 56% (IC del 95%: 45-67%; T2=0,05) y del 98% (IC del 95%: 96-99%; T2=0,01) respectivamente. El área bajo la curva fue de 0,92 (IC del 95%: 0,90-0,94). Las variables relacionadas con la prueba índice, la prueba de referencia, la puntuación global QUDAS-2 y el idioma predijeron la heterogeneidad. Limitaciones: Heterogeneidad significativa, pequeño número de estudios, informe de corte selectivo y la falta de un análisis de coste-efectividad. Conclusión: las escalas GDS-15, HADS-D, PHQ-9, CAT-D y PROMIS se comportaron de forma similar con altos valores de especificidad.
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