摘要
背景新型冠状病毒感染(COVID-19)在全世界大规模流行,已经演变成一场全球的灾难性公共卫生危机;目前关于COVID-19患者院内死亡危险因素的结论尚不统一。目的通过Meta分析探讨COVID-19患者院内死亡的相关危险因素。方法计算机检索Cochrane Library、ScienceDirect、PubMed、Medline、万方数据知识服务平台、中国知网、维普期刊资源整合服务平台,搜索已发表的关于COVID-19患者院内死亡的病例对照研究,检索时限为建库至2021-10-01。筛选文献、提取资料并评价文献质量,采用Stata 15.1软件进行Meta分析,采用Meta回归探索可能的异质性来源。结果最终纳入80篇文献,共405157例患者,其中存活组349923例(86.37%),死亡组55234例(13.63%)。根据纽卡斯尔-渥太华量表(NOS)评分,均为高质量文献。Meta分析结果显示,男性(OR=1.49,95%CI(1.41,1.57),P<0.001)、年龄大(WMD=10.44,95%CI(9.79,11.09),P<0.001)、呼吸困难(OR=2.09,95%CI(1.80,2.43),P<0.001)、疲劳(OR=1.49,95%CI(1.31,1.69),P<0.001)、肥胖(OR=1.46,95%CI(1.43,1.50),P<0.001)、吸烟(OR=1.18,95%CI(1.14,1.23),P<0.001)、脑卒中(OR=2.26,95%CI(1.41,3.62),P<0.001)、肾脏疾病(OR=3.62,95%CI(3.26,4.03),P<0.001)、心血管疾病(OR=2.34,95%CI(2.21,2.47),P<0.001)、高血压(OR=2.23,95%CI(2.10,2.37),P<0.001)、糖尿病(OR=1.84,95%CI(1.74,1.94),P<0.001)、肿瘤(OR=1.86,95%CI(1.69,2.05),P<0.001)、肺部疾病(OR=2.38,95%CI(2.19,2.58),P<0.001)、肝脏疾病(OR=1.65,95%CI(1.36,2.01),P<0.001)、白细胞计数升高(WMD=2.03,95%CI(1.74,2.32),P<0.001)、中性粒细胞计数升高(WMD=1.77,95%CI(1.49,2.05),P<0.001)、总胆红素升高(WMD=3.19,95%CI(1.96,4.42),P<0.001)、天冬氨酸氨基转移酶升高(WMD=13.02,95%CI(11.70,14.34),P<0.001)、丙氨酸氨基转移酶升高(WMD=2.76,95%CI(1.68,3.85),P<0.001)、乳酸脱氢酶升高(WMD=166.91,95%CI(150.17,183.64),P<0.001)、尿素氮升高(WMD=3.11,95%CI(2.61,3.60),P<0.001)、肌酐升高(WMD=22.06,95%CI(19.41,24.72),P<0.001)、C反应蛋白升高(WMD=76.45,95%CI(71.33,81.56),P<0.001)、白介素6升高(WMD=28.21,95%CI(14.98,41.44),P<0.001)、红细胞沉降率升高(WMD=8.48,95%CI(5.79,11.17),P<0.001)是COVID-19患者院内死亡的危险因素;肌痛(OR=0.73,95%CI(0.62,0.85),P<0.001)、咳嗽(OR=0.87,95%CI(0.78,0.97),P=0.013)、呕吐(OR=0.73,95%CI(0.54,0.98),P=0.030)、腹泻(OR=0.79,95%CI(0.69,0.92),P=0.001)、头痛(OR=0.55,95%CI(0.45,0.68),P<0.001)、哮喘(OR=0.73,95%CI(0.69,0.78),P<0.001)、体质指数降低(WMD=-0.58,95%CI(-1.10,-0.06),P=0.029)、淋巴细胞计数降低(WMD=-0.36,95%CI(-0.39,-0.32),P<0.001)、血小板计数降低(WMD=-38.26,95%CI(-44.37,-32.15),P<0.001)、D-二聚体升高(WMD=0.79,95%CI(0.63,0.95),P<0.001)、凝血酶原时间升高(WMD=0.78,95%CI(0.61,0.94),P<0.001)、白蛋白降低(WMD=-1.88,95%CI(-2.35,-1.40),P<0.001)、降钙素原升高(WMD=0.27,95%CI(0.24,0.31),P<0.001)、肌钙蛋白升高(WMD=0.04,95%CI(0.03,0.04),P<0.001)是COVID-19患者院内死亡的保护因素。Meta回归结果显示,国家对性别、肾脏疾病、心血管疾病、哮喘、白细胞计数、中性粒细胞计数、血小板计数、血红蛋白、尿素氮的异质性均有统计学意义(P<0.05)。结论男性、年龄大、呼吸困难、疲劳、肥胖、吸烟、脑卒中、肾脏疾病、心血管疾病、高血压、糖尿病、肿瘤、肺部疾病、肝脏疾病,白细胞计数、中性粒细胞计数、总胆红素、天冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶、尿素氮、肌酐、C反应蛋白、白介素6、红细胞沉降率升高可能是COVID-19患者院内死亡的危险因素,肌痛、呕吐、腹泻、头痛、哮喘、体质指数降低、淋巴细胞计数降低、血小板计数降低、D-二聚体升高、凝血酶原时间升高、白蛋白降低、降钙素原升高、肌钙蛋白升高可能是COVID-19患者院内死亡的保护因素。本研究所得出的结论,尚需更多高质量、多中心、大样本、真实世界的研究进一步证实。
Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis,and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform.Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis.Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library,ScienceDirect,PubMed,Medline,Wanfang Data,CNKI and CQVIP from inception to October 1,2021.Literature screening,data extraction and methodological quality assessment were conducted.Meta-analysis was performed using Stata 15.1.Meta-regression was used to explore the potential sources of heterogeneity.Results Eighty studies were included which involving 405157 cases(349923 were survivors(86.37%),and 55234 deaths(13.63%)),that were rated as being of high quality by the Newcastle-Ottawa Scale.Meta-analysis showed that being male(OR=1.49,95%CI(1.41,1.57),P<0.001),older age(WMD=10.44,95%CI(9.79,11.09),P<0.001),dyspnoea(OR=2.09,95%CI(1.80,2.43),P<0.001),fatigue(OR=1.49,95%CI(1.31,1.69),P<0.001),obesity(OR=1.46,95%CI(1.43,1.50),P<0.001),smoking(OR=1.18,95%CI(1.14,1.23),P<0.001),stroke(OR=2.26,95%CI(1.41,3.62),P<0.001),kidney disease(OR=3.62,95%CI(3.26,4.03),P<0.001),cardiovascular disease(OR=2.34,95%CI(2.21,2.47),P<0.001),hypertension(OR=2.23,95%CI(2.10,2.37),P<0.001),diabetes(OR=1.84,95%CI(1.74,1.94),P<0.001),cancer(OR=1.86,95%CI(1.69,2.05),P<0.001),pulmonary disease(OR=2.38,95%CI(2.19,2.58),P<0.001),liver disease(OR=1.65,95%CI(1.36,2.01),P<0.001),elevated levels of white blood cell count(WMD=2.03,95%CI(1.74,2.32),P<0.001),neutrophil count(WMD=1.77,95%CI(1.49,2.05),P<0.001),total bilirubin(WMD=3.19,95%CI(1.96,4.42),P<0.001),aspartate transaminase(WMD=13.02,95%CI(11.70,14.34),P<0.001),alanine transaminase(WMD=2.76,95%CI(1.68,3.85),P<0.001),lactate dehydrogenase(WMD=166.91,95%CI(150.17,183.64),P<0.001),blood urea nitrogen(WMD=3.11,95%CI(2.61,3.60),P<0.001),serum creatinine(WMD=22.06,95%CI(19.41,24.72),P<0.001),C-reactive protein(WMD=76.45,95%CI(71.33,81.56),P<0.001),interleukin-6(WMD=28.21,95%CI(14.98,41.44),P<0.001),and erythrocyte sedimentation rate(WMD=8.48,95%CI(5.79,11.17),P<0.001)were associated with increased risk of in-hospital death for patients with COVID-19,while myalgia(OR=0.73,95%CI(0.62,0.85),P<0.001),cough(OR=0.87,95%CI(0.78,0.97),P=0.013),vomiting(OR=0.73,95%CI(0.54,0.98),P=0.030),diarrhoea(OR=0.79,95%CI(0.69,0.92),P=0.001),headache(OR=0.55,95%CI(0.45,0.68),P<0.001),asthma(OR=0.73,95%CI(0.69,0.78),P<0.001),low body mass index(WMD=-0.58,95%CI(-1.10,-0.06),P=0.029),decreased lymphocyte count(WMD=-0.36,95%CI(-0.39,-0.32),P<0.001),decreased platelet count(WMD=-38.26,95%CI(-44.37,-32.15),P<0.001),increased D-dimer(WMD=0.79,95%CI(0.63,0.95),P<0.001),longer prothrombin time(WMD=0.78,95%CI(0.61,0.94),P<0.001),lower albumin(WMD=-1.88,95%CI(-2.35,-1.40),P<0.001),increased procalcitonin(WMD=0.27,95%CI(0.24,0.31),P<0.001),and increased cardiac troponin(WMD=0.04,95%CI(0.03,0.04),P<0.001)were associated with decreased risk of in-hospital death due to COVID-19.According to the meta-regression result,the heterogeneity in gender,renal disease,cardiovascular diseases,asthma,white blood cell count,neutrophil count,platelet count,hemoglobin,and urea nitrogen differed siangificnatly by country(P<0.05).Conclusion The risk of in-hospital death due to COVID-19 may be increased by 25 factors(including being male,older age,dyspnoea,fatigue,obesity,smoking,stroke,kidney disease,cardiovascular disease,hypertension,diabetes,cancer,pulmonary disease,liver disease,elevated levels of white blood cells,neutrophil count,total bilirubin,aspartate transaminase,alanine transaminase,lactate dehydrogenase,blood urea nitrogen,serum creatinine,C-reactive protein,interleukin-6,and erythrocyte sedimentation rate),and may be decreased by 13 factors(including myalgia,cough,vomiting,diarrhoea,headache,asthma,low body mass index,decreased lymphocyte count and platelet count,increased D-dimer,longer prothrombin time,lower albumin,increased procalcitonin and cardiac troponin).The conclusion drawn from this study needs to be further confirmed by high-quality,multicenter,large-sample,real-world studies.
作者
张炜宗
袁红
孙金栋
於华敏
史明娟
胡海强
何海英
叶利
章慧慧
白幸华
沈超峰
屠思佳
汪洋
王刚
赵晓峰
余涛
李彩荣
张志
周栋徕
蔡梦阳
宁乐
ZHANG Weizong;YUAN Hong;SUN Jindong;YU Huamin;SHI Mingjuan;HU Haiqiang;HE Haiying;YE Li;ZHANG Huihui;BAI Xinghua;SHEN Chaofeng;TU Sijia;WANG Yang;WANG Gang;ZHAO Xiaofeng;YU Tao;LI Cairong;ZHANG Zhi;ZHOU Donglai;CAI Mengyang;NING Le(Cardiovascular Department,First People's Hospital of Linping District,Hangzhou 311100,China)
出处
《中国全科医学》
CAS
北大核心
2023年第5期607-620,共14页
Chinese General Practice
