Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis
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DOI：
10.1186/s12879-019-4318-3
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发表时间：
2019-08-02
影响因子：
3.7
通讯作者：
Xu, Cuiling
中科院分区：
文献类型：
--
作者：
Mertz, Dominik;Lo, Calvin Ka-Fung;Xu, Cuiling
背景 世卫组织确定孕妇因流感病毒感染而出现严重后果的风险增加，并建议她们优先接种流感疫苗。然而，支持这一点的证据并不一致。生态学研究特别表明，与基于个体患者数据的研究相比，怀孕期间感染流感的后果更为严重。然而，个别研究可能力度不足，并且正如之前的系统评价所报告的那样，无法调整混杂因素。因此，我们进行了个体参与者数据荟萃分析，以评估孕妇流感感染严重后果的风险，同时调整其他预后因素。方法 我们联系了最近发表的系统评价中包含的研究的作者。我们汇集了育龄妇女的个人参与者数据和流感病毒感染的实验室确认。我们使用广义线性混合模型并报告优势比 (OR) 和 95% 置信区间 (CI)。结果 共有 33 个数据集，包含 186,656 名个体的数据，其中包括 36,498 名符合条件的育龄妇女和已知怀孕状态的妇女。在多变量模型中，怀孕与入院风险增加 7 倍相关（OR 6.80，95% CI 6.02-7.68），在住院或门诊接受医疗护理的患者中，怀孕与入住重症监护病房的风险较低相关（ICU；OR 0.57，95% CI 0.48-0.69），并且与死亡没有显着相关（OR 1.00，95% CI 0.48-0.69）。 95%置信区间 0.75-1.34）。结论 我们的研究发现，与非孕妇相比，孕妇因流感相关住院的风险更高。我们没有发现寻求医疗护理的孕妇死亡率更高或入住 ICU 的可能性更高。然而，这项研究并没有解决真正的社区孕妇群体是否面临流感相关并发症的较高风险。
Background WHO identifies pregnant women to be at increased risk for severe outcomes from influenza virus infections and recommends that they be prioritized for influenza vaccination. The evidence supporting this, however, is inconsistent. Ecologic studies in particular suggest more severe outcomes from influenza infection during pregnancy than studies based on individual patient data. Individual studies however may be underpowered and, as reported in a previous systematic review, confounding factors could not be adjusted for. We therefore conducted an individual participant data meta-analysis to assess the risk for severe outcomes of influenza infection in pregnant women while adjusting for other prognostic factors. Methods We contacted authors of studies included in a recently published systematic review. We pooled the individual participant data of women of reproductive age and laboratory confirmation of influenza virus infection. We used a generalized linear mixed model and reported odds ratios (OR) and 95% confidence intervals (CI). Results A total of 33 datasets with data on 186,656 individuals were available, including 36,498 eligible women of reproductive age and known pregnancy status. In the multivariable model, pregnancy was associated with a 7 times higher risk of hospital admission (OR 6.80, 95%CI 6.02-7.68), among patients receiving medical care as in- or outpatients, pregnancy was associated with a lower risk of admission to intensive care units (ICU; OR 0.57, 95%CI 0.48-0.69), and was not significantly associated with death (OR 1.00, 95%CI 0.75-1.34). Conclusions Our study found a higher risk of influenza associated hospitalization among pregnant women as compared to non-pregnant women. We did not find a higher mortality rate or higher likelihood of ICU admission among pregnant women who sought medical care. However, this study did not address whether a true community based cohort of pregnant women is at higher risk of influenza associated complications.