Factors associated with dengue shock syndrome: a systematic review and meta-analysis.
Factors associated with dengue shock syndrome: a systematic review and meta-analysis.
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DOI：
10.1371/journal.pntd.0002412
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发表时间：
2013
影响因子：
3.8
通讯作者：
Hirayama K
中科院分区：
文献类型：
--
作者：
Huy NT;Van Giang T;Thuy DH;Kikuchi M;Hien TT;Zamora J;Hirayama K
登革休克综合征（DSS，3级和4级）的发病机制尚未完全了解。据报道，有几个因素与DSS有关，DSS是一种更严重的登革热感染形式，据报道，与没有DSS的登革热患者相比，其死亡率高出50倍。然而，这些报告的结果仍不确定。为了更好地了解DSS的流行病学，临床表现和发病机制，以开发新的治疗方法，我们系统地回顾并进行了相关研究的荟萃分析，报告了DSS和登革出血热（DHF，1级和2级）患者的因素。使用PubMed、EMBASE、Scopus、Google Scholar、Dengue Bulletin、科克伦图书馆、虚拟健康图书馆和手动检索2010年9月之前发表的文献参考文献列表来检索相关研究。使用固定效应或随机效应模型进行荟萃分析，计算合并比值比（OR）或事件发生率以及相应的95%置信区间。进一步进行异质性和发表偏倚评估、荟萃回归分析、亚组分析、敏感性分析和因素特异性关系分析。有198项研究构成了203个数据集，符合我们的资格标准。我们的荟萃回归分析显示，在东南亚，特别是泰国，DSS/登革出血热（DHF）比率在40年内持续下降。荟萃分析显示，年龄、女性、神经系统体征、恶心/呕吐、腹痛、消化道出血、血液浓缩、腹水、胸腔积液、低白蛋白血症、低蛋白血症、肝肿大、丙氨酸转氨酶和天冬氨酸转氨酶水平、血小板减少症、凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原水平、原发/继发感染、和登革病毒血清型-2与DSS显著相关。这些结果通过确定DSS中涉及的流行病学、临床体征和生物标志物之间的关联，提高了我们对DSS发病机制的认识。登革热是由受感染的蚊子传播的最常见的病毒性疾病之一。它的范围包括无症状或自限性登革热（DF）到以血浆泄漏为特征的严重登革热（登革出血热，DHF）和登革休克综合征（DSS）。登革热感染的死亡主要发生在DSS中，据报道，DSS的死亡率比没有DSS的登革热患者高50倍。在个别研究中报告了与DSS相关的几个因素;然而，一些因素的关联在研究中并不一致。因此，我们对文献进行了系统的回顾，以澄清这一问题。该研究显示，年龄较小、女性、神经系统体征、恶心/呕吐、腹痛、胃肠道出血、血液浓缩增加、腹水、胸腔积液、低白蛋白血症、低蛋白血症、肝肿大、ALT或AST水平升高、血小板减少症、凝血功能失调、继发感染和登革热病毒血清2型感染的人更有可能患有DSS。这一结果提高了我们对DSS临床表现和发病机制的认识。
The pathogenesis of dengue shock syndrome (DSS, grade 3 and 4) is not yet completely understood. Several factors are reportedly associated with DSS, a more severe form of dengue infection that reportedly causes 50 times higher mortality compared to that of dengue patients without DSS. However, the results from these reports remain inconclusive. To better understand the epidemiology, clinical manifestation, and pathogenesis of DSS for development of new therapy, we systematically reviewed and performed a meta-analysis of relevant studies that reported factors in both DSS and dengue hemorrhagic fever (DHF, grade 1 and 2) patients. PubMed, EMBASE, Scopus, Google Scholar, Dengue Bulletin, Cochrane Library, Virtual Health Library, and a manual search of reference lists of articles published before September 2010 were used to retrieve relevant studies. A meta-analysis using fixed- or random-effects models was used to calculate pooled odds ratios (OR) or event rate with corresponding 95% confidence intervals. Assessment of heterogeneity and publication bias, meta-regression analysis, subgroup analysis, sensitivity analysis, and analysis of factor-specific relationships were further performed. There were 198 studies constituting 203 data sets that met our eligibility criteria. Our meta-regression analysis showed a sustained reduction of DSS/dengue hemorrhagic fever (DHF) ratio over a period of 40 years in Southeast Asia, especially in Thailand. The meta-analysis revealed that age, female sex, neurological signs, nausea/vomiting, abdominal pain, gastrointestinal bleeding, hemoconcentration, ascites, pleural effusion, hypoalbuminemia, hypoproteinemia, hepatomegaly, levels of alanine transaminase and aspartate transaminase, thrombocytopenia, prothrombin time, activated partial thromboplastin time, fibrinogen level, primary/secondary infection, and dengue virus serotype-2 were significantly associated with DSS when pooling all original relevant studies. The results improve our knowledge of the pathogenesis of DSS by identifying the association between the epidemiology, clinical signs, and biomarkers involved in DSS. Dengue is one of the most common viral diseases transmitted by infected mosquitoes. It may range from asymptomatic or self-limiting dengue fever (DF) to severe dengue characterized by plasma leakage (dengue hemorrhagic fever, DHF) and dengue shock syndrome (DSS). Death from dengue infection occurs mostly in DSS, and the mortality of DSS is reportedly 50 times higher compared to that of dengue patients without DSS. Several factors associated with DSS have been reported in individual studies; however, the associations for some factors are not observed consistently across studies. Therefore, we conducted a systematic review of the literature to clarify this issue. The study showed persons with younger age, female sex, neurological signs, nausea/vomiting, abdominal pain, gastrointestinal bleeding, increased hemoconcentration, ascites, pleural effusion, hypoalbuminemia, hypoproteinemia, hepatomegaly, increased level of ALT or AST, thrombocytopenia, coagulation dysregulation, secondary infection, and infection of dengue virus serotype 2 are more likely to have DSS. This result improves our knowledge of the clinical manifestation and pathogenesis of DSS.
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影响因子：
15.8
作者：
Cummings DA;Iamsirithaworn S;Lessler JT;McDermott A;Prasanthong R;Nisalak A;Jarman RG;Burke DS;Gibbons RV
通讯作者：
Gibbons RV
影响因子：
5
作者：
GREENLAND, S;LONGNECKER, MP
通讯作者：
LONGNECKER, MP
影响因子：
1.9
作者：
Duval, S;Tweedie, R
通讯作者：
Tweedie, R
影响因子：
3.7
作者：
Bagiella, E;Sloan, RP;Heitjan, DF
通讯作者：
Heitjan, DF
影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H