慢性基础疾病与人感染H7N9禽流感病死风险校正关联性的Meta分析

Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis

目的探讨人感染H7N9禽流感患者病死风险与合并慢性基础疾病(UMCs)的关联。方法以"H7N9 avian influenza""chronic disease""mortality"等为关键词,检索Pub Med、Cochrane Library等外文数据库;以"H7N9禽流感""慢性病""死亡"等为关键词检索中国知网、万方医学等中文数据库,查找UMCs与人感染H7N9禽流感病死风险的相关文献,时间范围不限。采用Meta分析法计算合并风险比(OR)或校正风险比(AOR)。结果共检索到1 934篇文献,最终纳入14个病例对照/队列研究。Meta分析结果显示,人感染H7N9禽流感患者合并UMCs的病死风险是未合并者的2.20倍(95%CI:1.76~2.76)。亚组分析结果显示,合并慢性呼吸系统疾病(OR=4.43,95%CI:1.73~11.31)、免疫抑制性疾病(OR=4.65,95%CI:1.48~44.70)、≥2种UMCs(OR=2.13,95%CI:1.26~5.97)患者病死风险较高;在≥60岁(AOR=4.83,95%CI:1.29~18.09)、男性(AOR=2.35,95%CI:1.03~5.39)、达菲治疗时间间隔>5 d(AOR=5.74,95%CI:1.15~28.66)、住院治疗时间间隔>8 d(AOR=2.72,95%CI:1.20~6.15)、发病初期双肺感染(AOR=7.95,95%CI:1.56~40.41)的人感染H7N9禽流感患者中,合并UMCs的病死风险较高。分层分析结果显示,在人感染H7N9禽流感合并UMCs的患者中,≥60岁(AOR=2.20,95%CI:1.12~4.30)、达菲治疗时间间隔>5 d(AOR=3.19,95%CI:1.56~6.53)、发病初期双肺感染(AOR=3.48,95%CI:1.74~6.95)的病死风险较高。结论合并慢性呼吸系统疾病或免疫抑制性疾病或同时合并≥2种UMCs的人感染H7N9禽流感患者的病死风险增加,且在合并UMCs的人感染H7N9禽流感患者中,≥60岁、延迟达菲治疗和发病初期双肺感染的患者病死风险相对较高。

Objective The objective of our study was to conduct meta-analyses that examined the association between H7 N9-infected case-fatality risk（CFR） and underlying medical conditions（UMCs） by adjusting some potential factors variables. Methods The articles of observational studies and randomized controlled clinical trials（RCT） on the association between UMCs and the CFR of H7 N9-infected patients were collected and selected according to inclusion and exclusion criteria.Meta-analysis was performed to calculate odds ratio（OR） or adjusted OR（AOR） and 95% confidence interval（CI） to assess the association between H7 N9-infected CFR and UMCs. Results Among 1 934 screened articles, we identified 14 articles reporting the CFR of H7 N9-infected patients based on UMCs data. The pooled summary estimates from these studies indicated that UMCs significantly increased the risk of death in H7 N9 patients（OR=2.20,95%CI：1.76-2.76）. Subgroup analyses showed chronic respiratory diseases（CRD,OR=4.43,95%CI：1.73-11.31）,immuno-suppressive disorders（ISD,OR=4.65,95% CI：1.48-44.70）, and two UMCs and above（OR=2.13, 95% CI： 1.26-5.97） were significantly associated with H7 N9-infected CFR; while 60 years old and above（AOR=4.83, 95% CI： 1.29-18.09）, male（AOR=2.35, 95% CI： 1.03-5.39）, time intervals to oseltamivir treatment（over 5 days）（AOR=5.74, 95% CI： 1.15-28.66） and hospitalization（over 8 days）（AOR=2.72,95%CI：1.20-6.15）,and initially bilateral lungs infection（AOR=7.95,95%CI：1.56-40.41） of UMCs patients who died from H7 N9 infection are much greater compared with non-UMCs. Stratification analyses confirmed statistically significant increasing effects of CFR were observed in 60 years old and above（AOR=2.20, 95% CI： 1.12-4.30）, time intervals to oseltamivir treatment（over 5 days）（AOR=3.19, 95% CI： 1.56-6.53）, and initially bilateral lungs infection（AOR=3.48,95% CI： 1.74-6.95） compared with 0-59 years old, time intervals to oseltamivir treatment（5 days and below）, and initially single lung infection respectively in H7 N9-infected patients with UMCs. Conclusions We find that only CRD, ISD, and two UMCs and above are associated with increased risk of death in H7 N9-infected patients. We also suggest that a high CFR is associated with 60 years old and above, delayed antiviral treatment, and initially bilateral lungs infection in H7 N9-infected patients with UMCs.