危重症患者中流感相关肺曲霉病的患病率、危险因素、临床特征及结局：一项系统评价和荟萃分析
Prevalence, Risk Factors, Clinical Features, and Outcome of Influenza-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Systematic Review and Meta-Analysis.
作者信息
Lu Lawrence Y, Lee Hui Min, Burke Andrew, Li Bassi Gianluigi, Torres Antoni, Fraser John F, Fanning Jonathon P
机构信息
Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia; The Prince Charles Hospital, Chermside, QLD, Australia; The Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, QLD, Australia; The Princess Alexandra Hospital, Woolloongabba, QLD Australia.
Griffith University, Gold Coast, QLD, Australia.
出版信息
Chest. 2024 Mar;165(3):540-558. doi: 10.1016/j.chest.2023.09.019. Epub 2023 Sep 22.
BACKGROUND
Influenza-associated pulmonary aspergillosis (IAPA) increasingly is being reported in critically ill patients. We conducted this systematic review and meta-analysis to examine the prevalence, risk factors, clinical features, and outcomes of IAPA.
STUDY QUESTION
What are the prevalence, risk factors, clinical features, and outcomes of IAPA in critically ill patients?
STUDY DESIGN AND METHODS
Studies reporting IAPA were searched in the following databases: PubMed MEDLINE, CINAHL, Cochrane Library, Embase, Scopus, Cochrane Trials, and ClinicalTrials.gov. We performed one-group meta-analysis on risk factors, clinical features, morbidity, and mortality using random effects models.
RESULTS
We included 10 observational studies with 1,720 critically ill patients with influenza, resulting in an IAPA prevalence of 19.2% (331 of 1,720). Patients who had undergone organ transplantation (OR, 4.8; 95% CI, 1.7-13.8; I = 45%), harbored a hematogenous malignancy (OR, 2.5; 95% CI, 1.5-4.1; I = 0%), were immunocompromised (OR, 2.2; 95% CI, 1.6-3.1; I = 0%), and underwent prolonged corticosteroid use before admission (OR, 2.4; 95% CI, 1.4-4.3; I = 51%) were found to be at a higher risk of IAPA developing. Commonly reported clinical and imaging features were not particularly associated with IAPA. However, IAPA was associated with more severe disease progression, a higher complication rate, and longer ICU stays and required more organ supports. Overall, IAPA was associated with a significantly elevated ICU mortality rate (OR, 2.6; 95% CI, 1.8-3.8; I = 0%).
INTERPRETATION
IAPA is a common complication of severe influenza and is associated with increased mortality. Early diagnosis of IAPA and initiation of antifungal treatment are essential, and future research should focus on developing a clinical algorithm.
TRIAL REGISTRY
International Prospective Register of Systematic Reviews; No.: CRD42022284536; URL: https://www.crd.york.ac.uk/prospero/.
背景
重症患者中与流感相关的肺曲霉病（IAPA）的报告日益增多。我们进行了这项系统评价和荟萃分析，以研究IAPA的患病率、危险因素、临床特征和结局。
研究问题
重症患者中IAPA的患病率、危险因素、临床特征和结局是什么？
研究设计与方法
在以下数据库中检索报告IAPA的研究：PubMed MEDLINE、CINAHL、Cochrane图书馆、Embase、Scopus、Cochrane试验库和ClinicalTrials.gov。我们使用随机效应模型对危险因素、临床特征、发病率和死亡率进行单组荟萃分析。
结果
我们纳入了10项观察性研究，共1720例重症流感患者，IAPA患病率为19.2%（1720例中的331例）。接受过器官移植的患者（OR，4.8；95%CI，1.7 - 13.8；I² = 45%）、患有血行性恶性肿瘤的患者（OR，2.5；95%CI，1.5 - 4.1；I² = 0%）免疫功能低下的患者（OR，2.2；95%CI，1.6 - 3.1；I² = 0%）以及入院前长期使用皮质类固醇的患者（OR，2.4；95%CI，1.4 - 4.3；I² = 51%）被发现发生IAPA的风险更高。常见的临床和影像学特征与IAPA并无特别关联。然而，IAPA与更严重的疾病进展、更高的并发症发生率、更长的ICU住院时间以及需要更多的器官支持相关。总体而言，IAPA与ICU死亡率显著升高相关（OR，2.6；95%CI，1.8 - 3.8；I² = 0%）。
解读
IAPA是重症流感的常见并发症，与死亡率增加相关。IAPA的早期诊断和抗真菌治疗的启动至关重要，未来的研究应专注于开发临床算法。
试验注册
国际系统评价前瞻性注册库；编号：CRD42022284536；网址：https://www.crd.york.ac.uk/prospero/ 。
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