新型冠状病毒肺炎患者发生复合终点事件危险因素的meta分析

Risk factors for composite end point events in patients with coronavirus disease 2019:a meta-analysis

目的探索新型冠状病毒肺炎患者发生复合终点事件的危险因素。方法计算机检索PubMed、EMbase、Web of Science、MedRxiv、中国知网、万方和维普数据库,搜集新型冠状病毒肺炎患者发生复合终点事件的危险因素的队列研究、病例-对照研究和横断面研究,检索时限均从2019年11月至2020年3月27日。复合终点事件包括住进重症监护室(ICU),需要机械通气或死亡。采用RevMan 5.3和STATA14软件进行Meta分析。结果共纳入8个研究,包括46665例研究对象,涉及危险因素20个。Meta分析结果显示:年龄越大,男性,有高血压、糖尿病、慢性心脏病、脑血管疾病、肿瘤疾病、吸烟史等既往病史,肺部CT结果提示双侧肺部均有受累,以及丙氨酸转氨酶、天冬氨酸转氨酶、白细胞计数、中性粒细胞、肌酐、D二聚体、凝血酶原时间、超敏肌钙蛋白I水平越高的患者发生复合终点事件的风险可能更高;白蛋白,血小板计数和淋巴细胞计数的水平越低的患者发生复合终点事件的风险可能越高。结论年龄越大,有既往病史,存在心、肝、肾等其它脏器受累以及CT结果提示双侧肺部受累的患者发生复合终点事件的风险较高,临床上应给予重视,及早干预。

Objective To explore the risk factors forcomposite end point events in patients with coronavirus disease 2019(COVID-19).Methods PubMed,EMbase,Web of Science,MedRxiv,CNKI,WanFang and VIP databases were searched to collect cohort,case-control and cross-sectional studies on the risk factors for composite end point in patients with COVID-19 from November 2019 to March 27,2020.Composite end point events included the admission to an intensive care unit(ICU)with the use of mechanical ventilation,or death.Meta-analysis was performed by using RevMan 5.3 and STATA 14 software.Results A total of 8 studies involving 46665 objects and 20 risk factors were included.The results of meta-analysis showed that:The older males with history of hypertension,diabetes mellitus,chronic heart disease,cerebrovascular disease,tumor and smoking history,and whose CT showed bilateral lung involvement,as well as higher levels of alanine aminotransferase,glutamic oxalacetic aminotransferase,white blood cell count,neutrophils,creatinine,D dimer,prothrombin time and hypersensitive troponin I,may have higher risk of composite endpoint events.Patients with lower levels of albumin,platelet count,and lymphocyte count may have a higher risk of a composite endpoint events.Conclusion The older patients with pre-existing medical history,the presence of heart,liver,kidney and other organ involvement,and whose CT results suggest that bilateral lung involvement have a higher risk of composite endpoint events.Clinical attention should be paid to these patients and early intervention should be carried out.