Post-discharge morbidity and mortality in children admitted with severe anaemia and other health conditions in malaria-endemic settings in Africa: a systematic review and meta-analysis.
Post-discharge morbidity and mortality in children admitted with severe anaemia and other health conditions in malaria-endemic settings in Africa: a systematic review and meta-analysis.
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DOI：
10.1016/s2352-4642(22)00074-8
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发表时间：
2022-07
影响因子：
36.4
通讯作者：
Kuile, Feiko O. ter
中科院分区：
文献类型：
--
作者：
Kwambai, Titus K.;Mori, Amani T.;Nevitt, Sarah;van Eijk, Anna Maria;Samuels, Aaron M.;Robberstad, Bjarne;Phiri, Kamija S.;Kuile, Feiko O. ter
严重贫血与幼儿住院死亡率高有关。在疟疾流行地区，幸存儿童在出院后的几个月内死亡的风险也增加了。我们的目的是比较非洲疟疾流行环境中严重贫血康复后出院儿童与其他健康状况儿童的发病率和死亡率风险。根据PRISMA指南，我们在PubMed、Scopus、Web of Science和科克伦中心（Cochrane Central）中检索了从成立到2021年11月30日的数据，无语言限制，以查找前瞻性或回顾性队列研究和随机对照试验，这些研究对非洲疟疾流行国家15岁以下儿童出院后的规定时间段进行了随访。我们排除了试验和研究中的干预组，或涉及镰状细胞贫血、恶性肿瘤、手术或创伤儿童的亚组，或那些报告随访数据并结合住院期间的干预组。两位独立的评审员提取数据，并使用纽卡斯尔渥太华量表或科克伦协作组的工具评估偏倚的质量和风险。共同主要结局为全因死亡和出院后6个月全因再入院。本研究在PROSPERO注册，CRD 42017079282。在我们检索的2930篇文章中，纳入了27项研究。对于因严重贫血入院后最近出院的儿童，6个月内的全因死亡率高于住院期间（n=5项研究; Mantel-Haenszel比值比1.72，95%CI 1.22 - 2.44; p= 0.0020; I2= 51.5%），比既往入院无严重贫血的儿童高两倍以上（n=4项研究;相对危险度[RR] 2.69，95%CI 1.59 - 4.53; p<0.0001; I2= 69.2%）。在出院后6个月内，因严重贫血入院的儿童比因其他疾病入院的儿童更常见（n=1研究; RR 3.05，1.12 - 8.35; p<0.0001）。因严重急性营养不良入院的儿童（不考虑严重贫血）出院后6个月的死亡率也高于因其他原因入院的儿童（n=2项研究; RR= 3.12，2.02 - 4.68; p<0.0001; I2= 54.7%）。出院后死亡率的其他预测因素包括出院不遵医嘱、HIV、菌血症和缺氧。在非洲疟疾流行的环境中，与因其他健康状况入院的儿童相比，因严重贫血和严重急性营养不良入院的儿童在出院后的头6个月内死亡的风险更高。在出院后的这段时间里，需要改进这些高危群体的管理战略。
Severe anaemia is associated with high in-hospital mortality among young children. In malaria-endemic areas, surviving children also remain at increased risk of mortality for several months after hospital discharge. We aimed to compare the risks of morbidity and mortality among children discharged from hospital after recovery from severe anaemia versus other health conditions in malaria-endemic settings in Africa. Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, and Cochrane Central from inception to Nov 30, 2021, without language restrictions, for prospective or retrospective cohort studies and randomised controlled trials that followed up children younger than 15 years for defined periods after hospital discharge in malaria-endemic countries in Africa. We excluded the intervention groups in trials and studies or subgroups involving children with sickle cell anaemia, malignancies, or surgery or trauma, or those reporting follow-up data that were combined with the in-hospital period. Two independent reviewers extracted the data and assessed the quality and risk of bias using the Newcastle Ottawa Scale or the Cochrane Collaboration’s tool. The coprimary outcomes were all-cause death and all-cause readmissions 6 months after discharge. This study is registered with PROSPERO, CRD42017079282. Of 2930 articles identified in our search, 27 studies were included. For children who were recently discharged following hospital admission with severe anaemia, all-cause mortality by 6 months was higher than during the in-hospital period (n=5 studies; Mantel-Haenszel odds ratio 1·72, 95% CI 1·22–2·44; p=0·0020; I2=51·5%) and more than two times higher than children previously admitted without severe anaemia (n=4 studies; relative risk [RR] 2·69, 95% CI 1·59–4·53; p<0·0001; I2=69·2%). Readmissions within 6 months of discharge were also more common in children admitted with severe anaemia than in children admitted with other conditions (n=1 study; RR 3·05, 1·12–8·35; p<0·0001). Children admitted with severe acute malnutrition (regardless of severe anaemia) also had a higher 6-month mortality after discharge than those admitted for other reasons (n=2 studies; RR=3·12, 2·02–4·68; p<0·0001; I2=54·7%). Other predictors of mortality after discharge included discharge against medical advice, HIV, bacteraemia, and hypoxia. In malaria-endemic settings in Africa, children admitted to hospital with severe anaemia and severe acute malnutrition are at increased risk of mortality in the first 6 months after discharge compared with children admitted with other health conditions. Improved strategies are needed for the management of these high-risk groups during the period after discharge.
艾滋病毒对严重疟疾贫血儿童发病率和死亡率的影响。
影响因子：
3
作者：
Malamba, Samuel;Hladik, Wolfgang;Reingold, Arthur;Banage, Flora;McFarland, Willi;Rutherford, George;Mimbe, Derrick;Nzaro, Esau;Downing, Robert;Mermin, Jonathan
通讯作者：
Mermin, Jonathan