Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis.
Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis.
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DOI：
10.1093/ajcn/nqaa182
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发表时间：
2020-10-01
期刊：
影响因子：
--
通讯作者：
Prendergast AJ
中科院分区：
文献类型：
--
作者：
Karunaratne R;Sturgeon JP;Patel R;Prendergast AJ
全球45%的5岁以下儿童死亡是营养不良造成的。严重急性营养不良（SAM）是最严重的营养不良形式，其特征是伴有或不伴有水肿的消瘦。因复杂急性呼吸窘迫症需要住院治疗的儿童死亡率仍然很高（10%-40%）。我们的目的是系统地记录与SAM患儿住院死亡率相关的独立因素。Embase、Ovid MEDINE、Cochrane图书馆和clinicaltrials.gov使用预先指定的协议检索2000年1月至2020年1月期间发表的文章。符合条件的研究包括年龄≤59个月的SAM住院儿童，并使用多变量分析评估与住院患者死亡率独立相关的基线因素。随机效应荟萃分析，按规定的效应测量分层，使用> - 20%的研究在分析中包含相同的因素。1432项研究中有28项符合纳入标准：19项研究包括所有SAM儿童，9项研究包括SAM儿童的特定亚组。所有19项主要研究来自非洲的8个国家，每项研究中位数为400名儿童。平均住院死亡率为15.7% (95% CI: 10.4%, 21.0%)，艾滋病毒感染率为2.1%至51%。meta分析包括9个因素，按HR和OR分层。HIV感染（HR: 4.32; 95% CI: 2.31, 8.08）、体重/身高z评分（WHZ） （OR: 0.44; 95% CI: 0.24, 0.80）、腹泻（HR: 2.84; 95% CI: 1.40, 5.75）、肺炎（HR: 1.89; 95% CI: 1.19, 3.02）、休克（HR: 3.67; 95% CI: 2.24, 6.03）和食欲不振（HR: 2.16; 95% CI: 1.48, 3.16）与死亡率增加有关，而儿童年龄和性别与死亡率增加无关。从现有的研究中很难确定水肿和死亡率之间的关系。HIV感染、腹泻、肺炎、休克、食欲不振和WHZ降低是SAM患儿住院死亡率的独立预测因素。这些因素可能有助于对患有复杂SAM的住院儿童进行风险分层。该系统评价/荟萃分析方案在www.crd.york.ac.uk/prospero注册为CRD42019152267。
Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%–40%) among children requiring hospitalization for complicated SAM. We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses. Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM. This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.
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影响因子：
3.8
作者：
Chisti MJ;Shahid AS;Shahunja KM;Bardhan PK;Faruque ASG;Shahrin L;Das SK;Barua DK;Hossain MI;Ahmed T
通讯作者：
Ahmed T
影响因子：
168.9
作者：
Black, Robert E.;Victora, Cesar G.;Uauy, Ricardo
通讯作者：
Uauy, Ricardo
影响因子：
3.7
作者：
Chisti MJ;Salam MA;Bardhan PK;Faruque AS;Shahid AS;Shahunja KM;Das SK;Hossain MI;Ahmed T
通讯作者：
Ahmed T
影响因子：
16.8
作者：
Bourke CD;Berkley JA;Prendergast AJ
通讯作者：
Prendergast AJ
DOI：
10.1097/00005176-200105000-00011
发表时间：
2001-05-01
影响因子：
2.9
作者：
Amadi, B;Kelly, P;Chintu, C
通讯作者：
Chintu, C