Risk factors for invasive fungal disease in critically ill adult patients: a systematic review.
Risk factors for invasive fungal disease in critically ill adult patients: a systematic review.
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DOI：
10.1186/cc10574
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Harrison D
中科院分区：
文献类型：
--
作者：
Muskett H;Shahin J;Eyres G;Harvey S;Rowan K;Harrison D
英国每年发生超过5，000例侵袭性念珠菌感染病例，其中约40%发生在重症监护病房。重症患者的侵袭性真菌病（IFD）与发病率和死亡率的增加有关，这对个人和国家卫生服务都是一种代价。在本文中，我们报告了一项系统性综述的结果，该综述旨在识别和总结来自已发表的多变量分析、风险预测模型和危重成人患者IFD的临床决策规则的重要风险因素，为真菌感染风险评估研究的主要数据收集提供信息。进行互联网检索，以识别研究危重成人患者IFD的风险因素、风险预测模型或临床决策规则的文章。合格的文章在分阶段的过程中确定，并由两名研究者独立评估。使用一组涉及一般方法和统计方法的问题评估合格文章报告的方法学质量。13篇文章符合纳入标准，其中8篇研究了风险因素，4篇开发了风险预测模型或临床决策规则，1篇评价了临床决策规则。研究的目的、风险因素、定义和结果各不相同。在多项研究中发现以下风险因素与IFD显著相关：手术、全肠外营养、真菌定植、肾脏替代治疗、感染和/或败血症、机械通气、糖尿病和急性生理学和慢性健康评价II（APACHE II）或APACHE III评分。其他几个风险因素也仅在单一研究中被发现具有统计学意义。风险因素选择过程和建模策略也因研究而异，样本量不足以获得可靠的估计值。本综述显示了一些危险因素与危重成人IFD的发展显著相关。在设计和开展这一领域的研究时发现了方法上的局限性，在解释这些局限性时应谨慎。
Over 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units. Invasive fungal disease (IFD) in critically ill patients is associated with increased morbidity and mortality at a cost to both the individual and the National Health Service. In this paper, we report the results of a systematic review performed to identify and summarise the important risk factors derived from published multivariable analyses, risk prediction models and clinical decision rules for IFD in critically ill adult patients to inform the primary data collection for the Fungal Infection Risk Evaluation Study. An internet search was performed to identify articles which investigated risk factors, risk prediction models or clinical decisions rules for IFD in critically ill adult patients. Eligible articles were identified in a staged process and were assessed by two investigators independently. The methodological quality of the reporting of the eligible articles was assessed using a set of questions addressing both general and statistical methodologies. Thirteen articles met the inclusion criteria, of which eight articles examined risk factors, four developed a risk prediction model or clinical decision rule and one evaluated a clinical decision rule. Studies varied in terms of objectives, risk factors, definitions and outcomes. The following risk factors were found in multiple studies to be significantly associated with IFD: surgery, total parenteral nutrition, fungal colonisation, renal replacement therapy, infection and/or sepsis, mechanical ventilation, diabetes, and Acute Physiology and Chronic Health Evaluation II (APACHE II) or APACHE III score. Several other risk factors were also found to be statistically significant in single studies only. Risk factor selection process and modelling strategy also varied across studies, and sample sizes were inadequate for obtaining reliable estimates. This review shows a number of risk factors to be significantly associated with the development of IFD in critically ill adults. Methodological limitations were identified in the design and conduct of studies in this area, and caution should be used in their interpretation.
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DOI：
10.1007/s10096-007-0270-z
发表时间：
2007-04-01
影响因子：
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作者：
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