中国肝衰竭医院感染患者预后的Meta分析

Prognosis of liver failure related hospital infection in China: A Meta-analysis

目的:系统评价中国肝衰竭医院感染预后相关研究,分析医院感染预后指标,为改善预后提供循证依据.方法:检索中国知网、万方、维普、中国生物医学文献数据库、Pubmed、ISI web ofknowledge、Embase、Cochrane数据库文献,采用纽卡斯尔-渥太华量表对纳入文献进行质量评价及Meta分析.结果:纳入19篇文献,肝衰竭医院感染1989例,死亡1842例.Meta分析结果显示:肝衰竭医院感染患者在死亡组与存活组间(OR=4.13)、肝衰竭医院感染患者死亡在亚急性与慢性(OR=0.50)、单部位与多部位(OR=0.52)、血清总胆红素≤342.2μmol/L与>342.2μmol/L(OR=0.47)、血清白蛋白≤30 g/L与>30 g/L(OR=2.85)、凝血酶原活动度<20%与≥20%(OR=14.49)组间均有统计学意义.结论:影响肝衰竭医院感染患者预后指标复杂多样.慢性肝衰竭合并医院感染及多部位感染患者为重点监测对象,血清总胆红素>342.2μmol/L、血清白蛋白≤30 g/L、凝血酶原活动度<20%为重点监测指标.

AIM： To assess the prognosis of liver failure related hospital infection in China by systemati- cally reviewing all related studies. METHODS： We retrieved all clinical articles about the prognosis of liver failure related hos- pital infection in China in CNKI, Wanfang, VIP,CBM, PubMed, ISI web of knowledge, Embase and Cochrane library and evaluated the risk of bias of all included studies by Newcastle-Ottawa scale and analyzed all data by qualitative analy- sis and meta-analysis. RESULTS： Nineteen studies involving 1989 patients with liver failure related hospital in- fection, including 1842 deaths, were included. Meta-analysis results showed that the odds ratio of liver failure related hospital infection was sig- nificantly different between the death group and alive group （OR = 4.13）. The odds ratio of death was significantly different between subacute and chronic liver failure groups （OR=0.52）, be- tween total bilirubin （TBIL） ≤ 342.2 μmol/L and 〉 342.2 μmol/L groups （OR = 0.47）, between albumin （ALB） ≤ 30 g/L and 〉 30 g/L groups （OR = 2.85）, and between PTA 〈 20% and ≥ 20% groups （OR = 14.49）. CONCLUSION： The prognostic indexes of liver failure related hospital infection are complex and diverse. Chronic liver failure, multi-site hos- pital infection, TBIL 〉 342.2 μmol/L, ALB ≤ 30 g/L and PTA 〈 20% are key indexes.