Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis.
Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis.
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DOI：
10.1136/bmj.f5061
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发表时间：
2013-08-23
期刊：
影响因子：
--
通讯作者：
Loeb M
中科院分区：
文献类型：
--
作者：
Mertz D;Kim TH;Johnstone J;Lam PP;Science M;Kuster SP;Fadel SA;Tran D;Fernandez E;Bhatnagar N;Loeb M
目的评价季节性流感和大流行性流感患者严重结局的危险因素。设计系统评审。研究选择：观察性研究报告了流感患者感兴趣的危险因素-结果组合。结局包括死亡、呼吸机支持、入院、入住重症监护病房、肺炎和综合结局。数据来源Medline， Embase， CINAHL， Global Health和Cochrane中央对照试验注册库，截止到2011年3月。偏倚风险评估纽卡斯尔-渥太华量表评估偏倚风险。GRADE框架评价证据质量。结果共纳入文献63 537篇，其中符合纳入标准的文献234篇，共纳入受试者610 782人。支持流感严重后果的危险因素的证据从有限到没有。这与非2009年H1N1大流行和季节性流感研究相对缺乏数据尤其相关。已发表文献的局限性包括缺乏有效性和普遍缺乏对混杂因素的调整：在260项研究中的39项（15%）中，只有5%的风险因素-结果比较提供了调整后的风险估计。“任何危险因素”的证据水平较低（大流行性流感的死亡率优势比为2.77,95%可信区间为1.90至4.05，季节性流感的死亡率优势比为2.04,1.74至2.39），肥胖（2.74,1.56至4.80和30.1,1.74至2.39），心血管疾病（2.92,1.76至4.86和1.97,1.06至3.67），以及神经肌肉疾病（2.68,1.91至3.75和3.21,1.84至5.58）。其他所有危险因素的证据水平都很低。一些广为接受的危险因素，如怀孕和属于少数民族，不能确定为危险因素。相比之下，产后不到四周的妇女死于大流行性流感的风险显著增加（4.43,1.24至15.81）。结论支持流感相关并发症危险因素的证据水平较低，一些广为接受的危险因素，包括妊娠和种族，不能确认为危险因素。需要进行严格和充分有力的研究。
Objective To evaluate risk factors for severe outcomes in patients with seasonal and pandemic influenza. Design Systematic review. Study selection Observational studies reporting on risk factor-outcome combinations of interest in participants with influenza. Outcomes included death, ventilator support, admission to hospital, admission to an intensive care unit, pneumonia, and composite outcomes. Data sources Medline, Embase, CINAHL, Global Health, and the Cochrane Central Register of Controlled Trials to March 2011. Risk of bias assessment Newcastle-Ottawa scale to assess the risk of bias. GRADE framework to evaluate the quality of evidence. Results 63 537 articles were identified of which 234 with a total of 610 782 participants met the inclusion criteria. The evidence supporting risk factors for severe outcomes of influenza ranged from being limited to absent. This was particularly relevant for the relative lack of data for non-2009 H1N1 pandemics and for seasonal influenza studies. Limitations in the published literature included lack of power and lack of adjustment for confounders was widespread: adjusted risk estimates were provided for only 5% of risk factor-outcome comparisons in 39 of 260 (15%) studies. The level of evidence was low for “any risk factor” (odds ratio for mortality 2.77, 95% confidence interval 1.90 to 4.05 for pandemic influenza and 2.04, 1.74 to 2.39 for seasonal influenza), obesity (2.74, 1.56 to 4.80 and 30.1, 1.74 to 2.39), cardiovascular diseases (2.92, 1.76 to 4.86 and 1.97, 1.06 to 3.67), and neuromuscular disease (2.68, 1.91 to 3.75 and 3.21, 1.84 to 5.58). The level of evidence was very low for all other risk factors. Some well accepted risk factors such as pregnancy and belonging to an ethnic minority group could not be identified as risk factors. In contrast, women who were less than four weeks post partum had a significantly increased risk of death from pandemic influenza (4.43, 1.24 to 15.81). Conclusion The level of evidence to support risk factors for influenza related complications is low and some well accepted risk factors, including pregnancy and ethnicity, could not be confirmed as risks. Rigorous and adequately powered studies are needed.
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