基于ICU严重脓毒症患者死亡危险因素的系统回顾和Meta分析

Systematic review and meta analysis of risk factors for death in ICU patients with severe sepsis

目的通过对严重脓毒症患者死亡相关危险因素的系统回顾和分析,为创伤后并发脓毒症的治疗,降低严重脓毒症患者病死率提供循证医学依据。方法检索时间从建库开始至2021年1月31日,检索平台包括PubMed、EMBASE、Cochrane、中国知网和万方数据库;检索关键词:“脓毒症”、“危险因素”,“sepsis”、“risk factors”以及关键词中的独立项。根据制定标准完成文献筛选,并从纳入文献中提取独立危险因素的比值比(OR)、95%可信区间(CI)的上、下限值和P值,构建森林图,用I 2值判断模型的异质性。结果共纳入23篇文献报道中的62个危险因素,涉及42850例患者。其中10个危险因素可确定为ICU严重脓毒症患者死亡的独立危险因素,各危险因素OR值及其置信区间:年龄(>65岁)1.7(95%CI:1.53~1.89)、男性4.43(95%CI:2.02~9.72)、序贯器官衰竭评分1.37(95%CI:1.30~1.45)、急性生理与慢性健康评分Ⅱ1.11(95%CI:1.09~1.12)、简化急性生理评分Ⅱ1.02(95%CI:1.01~1.03)、肾功能衰竭3.03(95%CI:1.18~7.80)、院内感染2.49(95%CI:1.77~3.5)、泌尿系感染0.49(95%CI:0.36~0.66)、乳酸1.18(95%CI:1.16~1.20)、血培养阳性1.62(95%CI:1.15~2.29)。结论年龄>65岁、男性、序贯器官衰竭评分、急性生理与慢性健康评分Ⅱ、简化急性生理评分Ⅱ、肾功能衰竭、院内感染、泌尿系感染、乳酸和血培养阳性是ICU严重脓毒症患者死亡的独立危险因素。

Objective To provide evidence-based medical basis for the treatment of post-traumatic sepsis and for reducing the mortality of patients with severe sepsis.Methods The retrieval period was from the beginning of the database to Jan.31,2021,the search platform included PubMed,EMBASE,Cochane,CNKI and Wanfang database;the key words were as follows:sepsis,risk factors(in Chinese and English),and the independent items in the key words.The odds ratio,upper and lower limits of 95%confidence interval(CI)and P value of independent risk factors were extracted from the included literatures.The heterogeneity of the model was judged by I 2 value.Results A total of 62 risk factors were included in 23 articles,involving 42,850 patients.The OR values and confidence intervals of 10 independent risk factors for death in patients with severe sepsis included:age>65 years 1.7(95%CI:1.53-1.89),gender 4.43(95%CI:2.02-9.72),sequential organ failure assessment score 1.37(95%CI:1.30-1.45),acute physiology and chronic health evaluation score Ⅱ1.11(95%CI:1.09-1.12),simplified acute physiology score Ⅱ1.02(95%CI:1.01-1.03),renal failure 3.03(95%CI:1.18-7.80),nosocomial infection 2.49(95%CI:1.77-3.5),urinary infection 0.49(95%CI:0.36-0.66),lactic acid 1.18(95%CI:1.16-1.20)and positive blood culture 1.62(95%CI:1.15-2.29).Conclusion Our research shows that age(>65 years),gender(male),sequential organ failure assessment score,acute physiology and chronic health evaluation score Ⅱ,simplified acute physiology score Ⅱ,renal failure,nosocomial infection,urinary tract infection,positive lactic acid,and blood culture are independent risk factors for death in ICU patients with sepsis.