Institute for Infectious Diseases and Infection Control, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
Research Group Clinical Epidemiology, Center for Sepsis Control and Care (CSCC), Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.
Crit Care. 2020 Sep 29;24(1):584. doi: 10.1186/s13054-020-03296-5.
Herpes simplex virus (HSV) is frequently detected in the respiratory tract of mechanically ventilated patients. The aim of this study was to assess current evidence to determine whether antiviral therapy is associated with better outcomes in these patients.
MEDLINE, ISI Web of Science, Cochrane Database and ClinicalTrials.gov were searched from inception to 25 May 2020. All clinical studies investigating the effects of antiviral therapy on the outcome of mechanically ventilated ICU patients in whom HSV was detected in the respiratory tract were eligible for inclusion, regardless of study design, publication status or language. Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed and data extracted. We performed a random-effects meta-analysis to estimate relative risks (RRs) with corresponding 95% confidence intervals (CIs). The primary endpoint was hospital all-cause mortality.
Nine studies were included in the meta-analysis (one randomized controlled trial, eight cohort studies). Antiviral treatment was associated with lower hospital mortality (with antiviral treatment, 40.6% (189 out of 465 patients); without, 52.7% (193 out of 366 patients); RR 0.74 [0.64, 0.85]; eight studies, low quality of evidence). Furthermore, antiviral treatment was associated with lower 30-day mortality (RR 0.75 [0.59, 0.94]; three studies, very low quality of evidence). We did not observe evidence for differences in ICU mortality (RR 0.73 [0.51, 1.05]; three studies, very low quality of evidence).
This meta-analysis of the available data shows that antiviral therapy might result in lower hospital and 30-day all-cause mortality in mechanically ventilated ICU patients who are positive for HSV in the respiratory tract. However, this result must be interpreted with great caution due to the high risk of bias and limited number of patients. Large, well-designed randomized controlled clinical trials are urgently needed.
The study was registered in advance on International Prospective Register of Systematic Reviews (CRD42020180053) .
单纯疱疹病毒（HSV）在机械通气患者的呼吸道中经常被检测到。本研究旨在评估现有证据，以确定抗病毒治疗是否与这些患者的更好结局相关。
从 2020 年 5 月 25 日起，检索 MEDLINE、ISI Web of Science、Cochrane 数据库和 ClinicalTrials.gov。所有研究机械通气 ICU 患者的呼吸道中检测到 HSV 时，评估抗病毒治疗对其结局影响的临床研究均符合纳入标准，无论研究设计、发表状态或语言如何。两名作者分别独立审查标题和摘要。如果文章似乎符合条件，则进一步审查全文并提取数据。我们采用随机效应荟萃分析来估计相对风险（RR）及其相应的 95%置信区间（CI）。主要终点是医院全因死亡率。
共有 9 项研究纳入荟萃分析（1 项随机对照试验，8 项队列研究）。抗病毒治疗与降低医院死亡率相关（抗病毒治疗组 40.6%（465 例中的 189 例）；未治疗组 52.7%（366 例中的 193 例）；RR 0.74[0.64，0.85]；8 项研究，低质量证据）。此外，抗病毒治疗与降低 30 天死亡率相关（RR 0.75[0.59，0.94]；3 项研究，极低质量证据）。我们未发现 ICU 死亡率存在差异的证据（RR 0.73[0.51，1.05]；3 项研究，极低质量证据）。
对现有数据的荟萃分析表明，在呼吸道中 HSV 阳性的机械通气 ICU 患者中，抗病毒治疗可能会降低医院和 30 天全因死亡率。然而，由于偏倚风险高且患者数量有限，该结果必须谨慎解释。迫切需要进行大型、精心设计的随机对照临床试验。
该研究已提前在国际前瞻性系统评价注册库（CRD42020180053）注册。
