Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis.
Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis.
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DOI：
10.1186/s12889-016-3881-4
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发表时间：
2016-11-29
影响因子：
4.5
通讯作者：
Ohmagari N
中科院分区：
文献类型：
--
作者：
Matsuyama R;Nishiura H;Kutsuna S;Hayakawa K;Ohmagari N
虽然之前的研究已经探讨了中东呼吸综合征（MERS）严重并发症的风险及其决定因素，但尚未对具有不同设计和人群的已发表文章进行系统分析。本研究旨在系统地回顾与MERS相关的死亡风险以及相关并发症的风险因素。对PubMed和Web of Science数据库进行了检索，以查找关于MERS确诊病例的临床和流行病学研究。符合条件的文章报告了临床结局，特别是与MERS相关的严重并发症或死亡。评估患者入住重症监护室（ICU）、机械通气和死亡的风险。随后，探讨了MERS相关死亡与年龄、性别、基础疾病和研究设计之间的潜在关联。共识别出25篇合格文章。病死率风险范围为14.5%至100%，合并估计值为39.1%。ICU住院和机械通气的风险范围为44.4 - 100%和25.0 - 100%，合并估计值分别为78.2和73.0%。这些风险在已确定的研究中显示出实质性异质性，并且在关注ICU病例的病例研究中似乎最高。我们确定了年龄较大、男性和潜在的医疗条件，包括糖尿病、肾脏疾病、呼吸系统疾病、心脏病和高血压，作为MERS相关死亡的临床预测因素。在ICU病例研究中，有潜在心脏病或肾脏疾病的患者与无此类合并症的患者的预期死亡优势比（OR）为0.6（95%置信区间（CI）：0.1，4.3）和0.6（95% CI：0.0，2.1），而其他类型设计的研究中OR分别为3.8（95% CI：3.4，4.2）和2.4（95% CI：2.0，2.9）。研究中死亡和重度表现风险的异质性相当高，不同的研究设计是这种异质性的根本原因之一。必须对MERS死亡风险进行统计估计并确定风险因素，特别是考虑到研究设计以及与病例检测和诊断相关的潜在偏倚。本文的在线版本（doi：10.1186/s12889-016-3881-4）包含补充材料，可供授权用户使用。
While the risk of severe complications of Middle East respiratory syndrome (MERS) and its determinants have been explored in previous studies, a systematic analysis of published articles with different designs and populations has yet to be conducted. The present study aimed to systematically review the risk of death associated with MERS as well as risk factors for associated complications. PubMed and Web of Science databases were searched for clinical and epidemiological studies on confirmed cases of MERS. Eligible articles reported clinical outcomes, especially severe complications or death associated with MERS. Risks of admission to intensive care unit (ICU), mechanical ventilation and death were estimated. Subsequently, potential associations between MERS-associated death and age, sex, underlying medical conditions and study design were explored. A total of 25 eligible articles were identified. The case fatality risk ranged from 14.5 to 100%, with the pooled estimate at 39.1%. The risks of ICU admission and mechanical ventilation ranged from 44.4 to 100% and from 25.0 to 100%, with pooled estimates at 78.2 and 73.0%, respectively. These risks showed a substantial heterogeneity among the identified studies, and appeared to be the highest in case studies focusing on ICU cases. We identified older age, male sex and underlying medical conditions, including diabetes mellitus, renal disease, respiratory disease, heart disease and hypertension, as clinical predictors of death associated with MERS. In ICU case studies, the expected odds ratios (OR) of death among patients with underlying heart disease or renal disease to patients without such comorbidities were 0.6 (95% Confidence Interval (CI): 0.1, 4.3) and 0.6 (95% CI: 0.0, 2.1), respectively, while the ORs were 3.8 (95% CI: 3.4, 4.2) and 2.4 (95% CI: 2.0, 2.9), respectively, in studies with other types of designs. The heterogeneity for the risk of death and severe manifestations was substantially high among the studies, and varying study designs was one of the underlying reasons for this heterogeneity. A statistical estimation of the risk of MERS death and identification of risk factors must be conducted, particularly considering the study design and potential biases associated with case detection and diagnosis. The online version of this article (doi:10.1186/s12889-016-3881-4) contains supplementary material, which is available to authorized users.
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