WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Acta Psychiatr Scand. 2019 Sep;140(3):227-243. doi: 10.1111/acps.13066. Epub 2019 Jul 25.
To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics.
Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC).
Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 ± 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 ± 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 ± 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 ± 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 ± 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 ± 9.3 years).
The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.
量化与抗精神病药物暴露相关的髋部骨折、血栓栓塞、中风、心肌梗死、肺炎和心源性猝死风险。
从建立到 2018 年 7 月 30 日，系统地在 Medline、Embase 和 PsycINFO 中搜索了观察性研究的系统评价。使用 AMSTAR-2 对系统评价进行质量评估，使用 GRADE 和定量伞式审查标准（URC）来衡量关联强度。
纳入了来自 6 项系统评价的 68 项观察性研究。抗精神病药物暴露与肺炎的关联最强[URC=I 类；GRADE=低质量；比值比（OR）=1.84，95%置信区间（CI）=1.62-2.09；参与者=28726；年龄=76.2±12.3 岁]，其次是与髋部骨折（URC=II 类；GRADE=低质量；OR=1.57，95%CI=1.42-1.74；参与者=5288118；年龄=55.4±12.5 岁）和血栓栓塞（URC=II 类；GRADE=极低质量；OR=1.55，95%CI=1.31-1.83；参与者=31417175；年龄=55.5±3.2 岁）的关联。与中风（URC=III 类；GRADE=极低质量；OR=1.45，95%CI=1.24-1.70；参与者=65000；年龄=68.7±13.8 岁）、心源性猝死（URC=III 类；GRADE=极低质量；OR=2.24，95%CI=1.45-3.46；参与者=77488；年龄=52.2±6.2 岁）和心肌梗死（URC=III 类；GRADE=极低质量；OR=2.21，95%CI=1.41-3.46；参与者=399868；年龄=74.1±9.3 岁）的关联则较弱。
对于肺炎风险的研究结果最为可靠，其次是髋部骨折和血栓栓塞风险。对于中风、心源性猝死和心肌梗死，关联强度较弱。原始研究的观察性质可能是偏倚的一个来源。
