Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A metaanalysis
Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A metaanalysis
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DOI：
10.1378/chest.07-2182
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发表时间：
2008-06-01
期刊：
影响因子：
9.6
通讯作者：
Jindal, Surinder K.
中科院分区：
文献类型：
--
作者：
Agarwal, Ritesh;Srinivas, Rajagopala;Jindal, Surinder K.
背景和目的：ARDS可通过以下两种发病途径发生：直接肺损伤（ARDSp）；和间接伤害 (ARDSexp)。临床诱发因素可以影响ARDS的发病机制和临床结果。这项荟萃分析旨在评估两组之间的死亡率是否存在差异。 方法：我们检索了 MEDLINE、EMBASE 和 CINAHL 数据库中 1987 年至 2007 年发表的相关研究，并纳入了报告两组 ARDS 死亡率的研究。我们计算了比值比 (OR) 和 95% 置信区间 (CI)，以评估 ARDSp 患者与 ARDSexp 患者的死亡率，并使用三种不同的统计模型汇总结果。结果：我们的搜索产生了 34 项研究。总的来说，这些研究涉及 4,311 名患者，其中 ARDSp 组有 2,330 名患者，ARDSexp 组有 1,981 名患者。根据随机效应模型确定，ARDSp 组与 ARDSexp 组相比，死亡率 OR 为 1.11（95% CI，0.88 至 1.39）； 1.04（95% CI，0.92 至 1.18），由固定效应模型确定；根据精确方法测定，死亡率为 1.04（95% CI，0.92 至 1.18），表明两组的死亡率相似。无论研究是前瞻性研究（OR，1.15；95% CI，0.87 至 1.51）还是回顾性研究（OR，1.01；95% CI，0.61 至 1.69），死亡率均无差异；小（OR，1.11；95% CI，0.77 至 1.60）或大（OR，1.1；95% CI，0.82 至 1.49）；或观察性（OR，1.10；95% CI，0.82 至 1.49）或干预性（OR，0.97；95% CI，0.79 至 1.19）。存在方法学和统计异质性（I-2 50.9%；95% CI，21.3 至 66.2%；chi(2) 统计量，67.22；p = 0.0004）。结论：本研究的结果表明，这两组之间的死亡率没有差异。进一步的研究应关注亚组内的具体病因，而不是关注 ARDSp 和 ARDSexp 的更广泛划分。
Background and aim: ARDS can occur from the following two pathogenetic pathways: a direct pulmonary injury (ARDSp); and an indirect injury (ARDSexp). The predisposing clinical factor can influence the pathogenesis and clinical outcome of ARDS. This metaanalysis was aimed at evaluating whether there is any difference in mortality between the two groups.Methods: We searched the MEDLINE, EMBASE, and CINAHL databases for relevant studies published from 1987 to 2007, and included studies that have reported mortality in the two groups of ARDS. We calculated the odds ratio (OR) and 95% confidence interval (CI) to assess mortality in patients with ARDSp vs patients with ARDSexp and pooled the results using three different statistical models.Results: Our search yielded 34 studies. In all, the studies involved 4,311 patients with 2,330 patients in the ARDSp group and 1,981 patients in the ARDSexp group. The OR of mortality in ARDSp group compared to the ARDSexp group was 1.11 (95% CI, 0.88 to 1.39), as determined by the random-effects model; 1.04 (95% CI, 0.92 to 1.18), as determined by the fixed-effects model; and 1.04 (95% CI, 0.92 to 1.18), as determined by the exact method, indicating that mortality is similar in the two groups. The mortality was no different whether the studies were classified as prospective (OR, 1.15; 95% CI, 0.87 to 1.51) or retrospective (OR, 1.01; 95% CI, 0.61 to 1.69); small (OR, 1.11; 95% CI, 0.77 to 1.60) or large (OR, 1.1; 95% CI, 0.82 to 1.49); or observational (OR, 1.10; 95% CI, 0.82 to 1.49) or interventional (OR, 0.97; 95% CI, 0.79 to 1.19). There was methodological and statistical heterogeneity (I-2 50.9%; 95% CI, 21.3 to 66.2%; chi(2) statistic, 67.22; p = 0.0004).Conclusions: The results of this study suggest that there is no difference in mortality between these two groups. Further studies should focus on specific etiologies within the subgroups rather than focusing on the broader division of ARDSp and ARDSexp.