与病毒相关的急性下呼吸道感染住院患儿不良结局的危险因素：系统评价和荟萃分析。

Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis.

机构信息

From the Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom.

Randwick Clinical Campus, School of Clinical Medicine, UNSW Sydney, Sydney, New South Wales, Australia.

出版信息

Pediatr Infect Dis J. 2024 May 1;43(5):467-476. doi: 10.1097/INF.0000000000004258. Epub 2024 Jan 26.

DOI:10.1097/INF.0000000000004258

PMID:38285519

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11003409/

Abstract

BACKGROUND

Acute lower respiratory infection (ALRI) caused by respiratory viruses is among the most common causes of hospitalization and mortality in children. We aimed to identify risk factors for poor outcomes in children <5 years old hospitalized with ALRI caused by respiratory syncytial virus (RSV), influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

We searched Embase, Medline and Global Health databases and included observational studies reporting risk factors for poor outcomes (defined as use of supplemental oxygen, mechanical ventilation, intensive care unit admission, prolonged hospital stay and mortality) published between January 2011 and January 2023. Two authors independently extracted data on study characteristics, outcomes and risk factors. Due to limited data, meta-analyses were only conducted for RSV-ALRI poor outcome risk factors using random effects model when there were at least 3 studies.

RESULTS

We included 30 studies. For RSV-related ALRI, significant risk factors based on meta-analysis were: neurological disease [odds ratio (OR): 6.14; 95% confidence intervals (CIs): 2.39-15.77], Down's syndrome (5.43; 3.02-9.76), chronic lung disease (3.64; 1.31-10.09), immunocompromised status (3.41; 1.85-6.29), prematurity (2.98; 1.93-4.59), congenital heart disease (2.80; 1.84-4.24), underlying disease (2.45; 1.94-3.09), age <2 months (2.29; 1.78-2.94), age <6 months (2.08; 1.81-2.39), viral coinfection (2.01; 1.27-3.19), low birth weight (1.88; 1.19-2.95) and being underweight (1.80; 1.38-2.35). For influenza-related ALRI, chronic conditions and age 6-24 months were identified as risk factors for poor outcomes. Cardiovascular disease, immunosuppression, chronic kidney disease, diabetes and high blood pressure were reported as risk factors for mortality due to SARS-CoV-2 associated ALRI.

CONCLUSIONS

These findings might contribute to the development of guidelines for prophylaxis and management of ALRI caused by RSV, influenza and SARS-CoV-2.

摘要

背景

由呼吸道病毒引起的急性下呼吸道感染（ALRI）是导致儿童住院和死亡的最常见原因之一。我们旨在确定由呼吸道合胞病毒（RSV）、流感和严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 5 岁以下 ALRI 住院患儿不良结局的危险因素。

方法

我们检索了 Embase、Medline 和全球健康数据库，并纳入了自 2011 年 1 月至 2023 年 1 月期间发表的报告 RSV、流感和 SARS-CoV-2 相关 ALRI 不良结局（定义为使用补充氧气、机械通气、重症监护病房入院、住院时间延长和死亡）风险因素的观察性研究。两位作者独立提取研究特征、结局和风险因素的数据。由于数据有限，仅当至少有 3 项研究时，才使用随机效应模型对 RSV-ALRI 不良结局风险因素进行荟萃分析。

结果

我们纳入了 30 项研究。对于 RSV 相关的 ALRI，基于荟萃分析的显著危险因素包括：神经系统疾病[比值比（OR）：6.14；95%置信区间（CI）：2.39-15.77]、唐氏综合征（5.43；3.02-9.76）、慢性肺部疾病（3.64；1.31-10.09）、免疫功能低下状态（3.41；1.85-6.29）、早产（2.98；1.93-4.59）、先天性心脏病（2.80；1.84-4.24）、基础疾病（2.45；1.94-3.09）、年龄<2 个月（2.29；1.78-2.94）、年龄<6 个月（2.08；1.81-2.39）、病毒合并感染（2.01；1.27-3.19）、低出生体重（1.88；1.19-2.95）和体重不足（1.80；1.38-2.35）。对于流感相关的 ALRI，确定了慢性疾病和 6-24 个月龄是不良结局的危险因素。心血管疾病、免疫抑制、慢性肾脏疾病、糖尿病和高血压被报道为 SARS-CoV-2 相关 ALRI 死亡的危险因素。