Therapeutic Hypothermia and the Risk of Infection: A Systematic Review and Meta-Analysis
Therapeutic Hypothermia and the Risk of Infection: A Systematic Review and Meta-Analysis
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DOI：
10.1097/ccm.0b013e3182a276e8
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发表时间：
2014-02-01
影响因子：
8.8
通讯作者：
van der Worp, H. Bart
中科院分区：
文献类型：
--
作者：
Geurts, Marjolein;Macleod, Malcolm R.;van der Worp, H. Bart
目的：观察性研究表明，感染是低温治疗的常见并发症。我们对随机试验进行了系统性回顾和荟萃分析，以检查接受低温治疗的患者的感染风险。数据来源：PubMed、Embase和科克伦对照试验中心，系统性检索了截至2012年10月1日的合格研究。研究选择：我们纳入了针对任何适应症在成人中诱导治疗性低温的随机对照临床试验，报告了每个治疗组的感染患病率。数据提取：对于每项研究，我们收集了有关患者基线特征、冷却策略和感染的信息。数据合成：确定了23项研究，其中包括2，820例患者，其中1，398例（49.6%）随机接受低温治疗。来自另外31项随机试验（涉及4，004例患者）的数据无法纳入，因为感染的发生没有报告足够的细节或根本没有报告。纳入研究的偏倚风险很高，因为大多数情况下缺乏关于随机化方法和感染定义的信息，并且感染评估未设盲。在接受低温治疗的患者中，所有感染的患病率均未增加（率比，1.21 [95%CI，0.95-1.54]），但肺炎和脓毒症的风险增加（风险比分别为1.44 [95%CI，1.10-1.90]; 1.80 [95%CI，1.04-3.10]）。现有的证据，受其局限性，强烈表明治疗性低温与肺炎和脓毒症的风险之间存在关联，而没有观察到感染的总体风险增加。所有未来的低温随机试验都应该报道这一重要并发症。
Objective: Observational studies suggest that infections are a common complication of therapeutic hypothermia. We performed a systematic review and meta-analysis of randomized trials to examine the risk of infections in patients treated with hypothermia.Data Sources: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were systematically searched for eligible studies up to October 1, 2012.Study Selection: We included randomized controlled clinical trials of therapeutic hypothermia induced in adults for any indication, which reported the prevalence of infection in each treatment group.Data Extraction: For each study, we collected information about the baseline characteristics of patients, cooling strategy, and infections.Data Synthesis: Twenty-three studies were identified, which included 2,820 patients, of whom 1,398 (49.6%) were randomized to hypothermia. Data from another 31 randomized trials, involving 4,004 patients, could not be included because the occurrence of infection was not reported with sufficient detail or not at all. The risk of bias in the included studies was high because information on the method of randomization and definitions of infections lacked in most cases, and assessment of infections was not blinded. In patients treated with hypothermia, the prevalence of all infections was not increased (rate ratio, 1.21 [95% CI, 0.95-1.54]), but there was an increased risk of pneumonia and sepsis (risk ratios, 1.44 [95% CI, 1.10-1.90]; 1.80 [95% CI, 1.04-3.10], respectively).Conclusion: The available evidence, subject to its limitations, strongly suggests an association between therapeutic hypothermia and the risk of pneumonia and sepsis, whereas no increase in the overall risk of infection was observed. All future randomized trials of hypothermia should report on this important complication.