From the University of California San Francisco School of Medicine (E.S.); University of California San Francisco Graduate Division (P.L.); University of California San Francisco (A.I.N.); Zuckerberg San Francisco General (S.L.) San Francisco; and Department of Surgery (C.J.), University of California, Los Angeles, Los Angeles, California.
J Trauma Acute Care Surg. 2020 Apr;88(4):536-545. doi: 10.1097/TA.0000000000002464.
The negative effect of cirrhosis on mortality following traumatic injury has been quantified in multiple observational studies. However, to our knowledge, the information contained in these studies has never been synthesized. The aims of this study were: (1) to determine the magnitude of the effect of liver cirrhosis on mortality, morbidity, and hospital course among trauma patients and (2) to analyze sources of study heterogeneity that may lead to differing estimates in the observed mortality rate among patients with cirrhosis.
A systematic search of EMBASE and PubMed was conducted. Data were extracted from eligible studies and analyzed using a random-effects model to compare trauma outcomes in cirrhotic and noncirrhotic patients (PROSPERO Registration CRD42018088464). Mortality was the primary outcome. Secondary outcomes included complication rate, length of hospital stay, length of intensive care unit stay, and mechanical ventilation days.
Title and abstract review of 15,958 articles led to the identification of 31 relevant articles. Ultimately, 18 observational studies were included in this meta-analysis. The pooled effect sizes for mortality (odds ratio [OR], 4.52; 95% confidence interval [CI], 3.13-6.54) and complication rate (OR, 1.92; 95% CI, 1.30-2.85) were higher in the cirrhotic group than the noncirrhotic group. Trauma patients with cirrhosis also incurred longer hospital stays (mean difference, 3.81 days; 95% CI, 1.22-6.41) and longer ICU stays (mean difference, 2.40 days; 95% CI, 0.65-4.15). There was no difference in days spent on mechanical ventilation.
Preexisting liver cirrhosis is associated with increased mortality rate, complication rate, and length of hospitalization among trauma patients, even after adjusting for confounding factors and potential sources of between-study heterogeneity. Trauma patients with cirrhosis would benefit from heightened surveillance and injury prevention interventions.
Systematic review and meta-analysis, level III.
多项观察性研究已经量化了肝硬化对创伤后死亡率的负面影响。然而，据我们所知，这些研究中包含的信息从未被综合过。本研究的目的是：(1)确定肝硬化对创伤患者死亡率、发病率和住院过程的影响程度；(2)分析导致观察到的肝硬化患者死亡率差异的研究异质性来源。
对 EMBASE 和 PubMed 进行了系统检索。从合格的研究中提取数据，并使用随机效应模型进行分析，以比较肝硬化和非肝硬化患者的创伤结果（PROSPERO 注册 CRD42018088464）。死亡率是主要结果。次要结果包括并发症发生率、住院时间、重症监护病房住院时间和机械通气天数。
对 15958 篇文章的标题和摘要进行审查后，确定了 31 篇相关文章。最终，有 18 项观察性研究纳入了这项荟萃分析。肝硬化组的死亡率（比值比[OR]，4.52；95%置信区间[CI]，3.13-6.54）和并发症发生率（OR，1.92；95%CI，1.30-2.85）的汇总效应均高于非肝硬化组。患有肝硬化的创伤患者的住院时间（平均差异，3.81 天；95%CI，1.22-6.41）和 ICU 住院时间（平均差异，2.40 天；95%CI，0.65-4.15）也更长。机械通气天数没有差异。
即使在调整了混杂因素和潜在的研究间异质性来源后，肝硬化的存在与创伤患者的死亡率、并发症发生率和住院时间的增加有关。肝硬化的创伤患者将受益于加强监测和损伤预防干预。
系统评价和荟萃分析，三级。
