肾移植术后新型冠状病毒感染受者院内死亡影响因素的系统评价与Meta分析

Mortality relevant factors of COVID-19 infection in kidney transplantation recipients:a systematic review and Meta-analysis

目的探讨肾移植术后新型冠状病毒感染受者院内死亡影响因素,以期为早期识别受者死亡影响因素提供循证医学依据。方法以"肾移植""新型冠状病毒肺炎""新型冠状病毒";"kidney transplantation""COVID-19""SARS-CoV-2""novel coronavirus disease"为中英文关键词,检索PubMed、Web of Science、Medline、Scopus、Cochrane Library、中国知网、万方数据库中,国内、外关于肾移植术后新型冠状病毒感染受者院内死亡影响因素的相关研究,检索时限为建库至2022年8月20日。由2位研究员独立完成筛选文献、提取资料并评价纳入文献的偏倚风险,采用StataSE 12.0软件进行Meta分析。结果共纳入29项研究,包括7978例受者。Meta分析结果显示,年龄≥60岁(OR=1.09,95%CI:1.06~1.13)、有糖尿病病史(OR=1.49,95%CI:1.26~1.76)、心血管疾病病史(OR=1.88,95%CI:1.33~2.65)、发生急性肾损伤(OR=3.46,95%CI:1.35~8.89)、出现呼吸困难症状(OR=2.17,95%CI:1.38~3.42)、高血红蛋白(OR=1.09,95%CI:1.00~1.19)、使用霉酚酸制剂(OR=1.18,95%CI:1.02~1.37)、使用抗生素(OR=7.26,95%CI:2.11~25.07)是肾移植术后新型冠状病毒感染受者院内死亡的危险因素(P<0.05);出现腹泻症状(OR=0.57,95%CI:0.34~0.96)和高肾小球滤过率(OR=0.95,95%CI:0.92~0.98)是肾移植术后新型冠状病毒感染受者院内死亡的保护因素(P<0.05)。肾移植术后新型冠状病毒感染受者院内合并病死率为19%,95%CI为15%~23%。结论当前证据显示,年龄≥60岁、有糖尿病病史、心血管疾病病史、发生急性肾损伤、出现呼吸困难症状、高血红蛋白、使用霉酚酸制剂、使用抗生素是肾移植术后新型冠状病毒感染受者院内死亡的危险因素,出现腹泻症状和高肾小球滤过率是肾移植术后新型冠状病毒感染受者院内死亡的保护因素。

Objective To assess the evidence for relevant factors associated with mortality in COVID-19 kidney transplantation recipients(KTR)through Meta-analysis.Methods A complete search of PubMed,Web of Science,Medline,Scopus,Cochrane Library,CNKI and Wanfang Database were performed to search for eligible studies on 18 August 2022.Results twenty-nine studies involving 7978 Cases were included in our Meta-analysis.Patients with mean age≥60 years(OR=1.09,95%CI:1.06-1.13),Comorbidities including diabetes mellitus(OR=1.49,95%CI:1.26-1.76),cardiovascular disease(OR=1.88,95%CI:1.33-2.65),and acute kidney injury(OR=3.46,95%CI:1.35-8.89)significantly increased mortality risk.KTR with dyspnea(OR=2.17,95%CI:1.38-3.42),higher Hemoglobin(OR=1.09,95%CI:1.00-1.19),Use of mycophenolic(OR=1.18,95%CI:1.02-1.37)and Antibiotics(OR=7.26,95%CI:2.11-25.07)at presentation were at higher mortality risk,while diarrhea(OR=0.57,95%CI:0.34-0.96)and higher eGFR(OR=0.95,95%CI:0.92-0.98)decreased the risk.Overall in-hospital mortality in COVID-19 KTR was 19%,95%CI:15%-23%.Conclusions Our systematic review and-analysis results suggest that overall in-hospital mortality in COVID-19 KTR declined progressively over time.KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.