Survival Outcomes in Acute Invasive Fungal Sinusitis: A Systematic Review and Quantitative Synthesis of Published Evidence
Survival Outcomes in Acute Invasive Fungal Sinusitis: A Systematic Review and Quantitative Synthesis of Published Evidence
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DOI：
10.1002/lary.23912
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发表时间：
2013-05-01
期刊：
影响因子：
2.6
通讯作者：
Hwang, Peter H.
中科院分区：
文献类型：
--
作者：
Turner, Justin H.;Soudry, Ethan;Hwang, Peter H.
目的/假设：急性侵袭性真菌性鼻窦炎是一种侵袭性感染，常为致命性感染。尽管内科和外科治疗有所改善，但存活率仍然有限，影响患者预后的因素仍然知之甚少。本研究对已发表的文献进行系统回顾和定量综合，以确定与生存相关的预后因素。研究设计：系统综述。方法：52项研究，共807名符合纳入标准的患者，用于分析治疗、表现和结果。结果：根据牛津循证医学中心提供的定义，所有研究均被归类为4级证据。AIFS患者最常见的症状是面部肿胀(64.5%)、发热(62.9%)和鼻塞(52.2%)。大多数患者采用静脉注射抗真菌药物和手术相结合的治疗方法。总存活率为49.7%。单因素分析显示，预后不良与肾/肝衰竭、精神状态改变和颅内扩张有关。患有糖尿病、接受过手术或接受两性霉素B脂质体治疗的患者存活率较高。多因素分析显示，高龄和颅内受累是影响预后的独立因素。积极的预后因素再次包括糖尿病和手术切除。结论：AIF患者的总体死亡率仍然很高，只有一半的患者存活。糖尿病患者的总体存活率似乎比其他合并疾病的患者要好。有颅内受累的患者，或者没有接受手术作为治疗的一部分，预后很差。
Objectives/Hypothesis: Acute invasive fungal sinusitis (AIFS) is an aggressive and often fatal infection. Despite improvements in medical and surgical therapy, survival remains limited and the factors that contribute to patient outcomes remain poorly understood. The current study systematically reviews and quantitatively synthesizes the published literature to characterize prognostic factors associated with survival.Study Design: Systematic review.Methods: Fifty-two studies comprising a total of 807 patients met inclusion criteria and were used for analysis of treatment, presentation, and outcomes. Univariate and multivariate logistic regression was used to identify prognostic factors.Results: All studies were classified as level 4 evidence, as per definitions provided by the Oxford Center for Evidence-Based Medicine. The most common presenting symptoms of patients with AIFS were facial swelling (64.5%), fever (62.9%), and nasal congestion (52.2%). Most patients were treated with a combination of intravenous antifungal medication and surgery. The overall survival rate was 49.7%. On univariate analysis, poor prognosis was associated with renal/liver failure, altered mental status, and intracranial extension. Patients who were diabetic, had surgery, or received liposomal amphotericin B had an improved chance of survival. On multivariate analysis, advanced age and intracranial involvement were identified as independent negative prognostic factors. Positive prognostic factors again included diabetes and surgical resection.Conclusions: The overall mortality of patients with AIFS remains high, with only half of the patients surviving. Diabetic patients appear to have a better overall survival than patients with other comorbidities. Patients who have intracranial involvement, or who do not receive surgery as part of their therapy, have a poor prognosis.