Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada.
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; Division of Infectious Diseases, Departments of Internal Medicine, Soon Chun Hyang University Seoul Hospital, Seoul, Republic of Korea.
PLoS One. 2014 Mar 6;9(3):e89697. doi: 10.1371/journal.pone.0089697. eCollection 2014.
Little is known about risk factors for severe outcomes in patients infected with H5N1 and no systematic review has been conducted. Understanding risk factors is an important step for prioritizing prophylaxis or treatment in the event of a pandemic.
To systematically evaluate risk factors for severe outcomes in patients with avian influenza H5N1 infection.
MEDLINE, EMBASE, CINAHL, GlobalHealth, and CENTRAL through March 2011.
Observational studies of any design published in English, French, Spanish, German or Korean that reported on risk factor-outcome combinations of interest in participants with confirmed H5N1 infections. Outcomes considered included death, ventilator support, hospital and ICU admission, pneumonia, and composite outcomes.
Risk of bias was assessed using the Newcastle-Ottawa scale (NOS).
We identified 20 studies reporting on 999 patients infected with H5N1. The majority of studies (n = 14, 70%) were at intermediate risk of bias, i.e. 4-6 points on the NOS. Females were at increased risk of death (OR 1.75, 95% CI 1.27-2.44), while young age, in particular <5 years of age (OR 0.44, 95% CI 0.25-0.79 for death), was protective. Data on traditional risk factors was scarce and requires further studies. Another major limitation in the published literature was lack of adjustment for confounders.
Females were at increased risk for complications following H5N1 infection while young age protected against severe outcomes. Research on traditional risk factors was limited and is required.
对于感染 H5N1 的患者发生严重后果的风险因素知之甚少，也尚未进行系统评价。了解风险因素是在大流行时确定预防或治疗重点的重要步骤。
系统评价人感染 H5N1 禽流感的严重后果的相关风险因素。
MEDLINE、EMBASE、CINAHL、GlobalHealth 和 CENTRAL，检索时限均至 2011 年 3 月。
以任何设计发表的英文、法文、西班牙文、德文或韩文文献，报道确诊 H5N1 感染患者的风险因素-结局组合，均纳入观察性研究。考虑的结局包括死亡、呼吸机支持、住院和 ICU 入院、肺炎和复合结局。
使用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。
我们共识别出 20 项研究，报道了 999 例感染 H5N1 的患者。大多数研究（n=14，70%）的偏倚风险为中等，即 NOS 评分为 4-6 分。女性死亡风险增加（OR 1.75，95%CI 1.27-2.44），而年龄较小，尤其是＜5 岁（OR 0.44，95%CI 0.25-0.79）则具有保护作用。关于传统风险因素的数据很少，需要进一步研究。发表文献的另一个主要局限性是缺乏混杂因素的调整。
女性感染 H5N1 后并发症风险增加，而年龄较小则可预防严重后果。关于传统风险因素的研究有限，需要进一步研究。
