Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Br J Anaesth. 2021 Jul;127(1):32-40. doi: 10.1016/j.bja.2021.02.023. Epub 2021 Mar 29.
In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis.
We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0-1.5×10 L. Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the Newcastle-Ottawa Scale. The I index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days.
Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46-91 yr; female, 20-79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the Newcastle-Ottawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]=3.22; 95% confidence interval [CI], 2.19-4.72; P<0.01, I=0%) and more frequent major postoperative complications (RR=1.33; 95% CI, 1.21-1.45; P<0.01, I=6%), including cardiovascular morbidity (RR=1.77; 95% CI, 1.45-2.15; P<0.01, I=0%), infections (RR=1.45; 95% CI, 1.19-1.76; P<0.01, I=0%), and acute renal dysfunction (RR=2.66; 95% CI, 1.49-4.77; P<0.01, I=1%).
Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery.
CRD42020190702.
在普通成年人群中，淋巴细胞减少与感染住院风险增加以及感染相关死亡相关。尚未通过系统评价或荟萃分析检查不同手术过程中围手术期淋巴细胞减少与死亡率/发病率之间的证据质量和关联强度。
我们检索了 MEDLINE、Embase、Web of Science、Google Scholar 和 Cochrane 数据库，从它们的建立到 2020 年 6 月 29 日，以寻找报告成年人淋巴细胞计数和院内死亡率的观察性研究。我们将术前淋巴细胞减少定义为淋巴细胞计数 1.0-1.5×10^9/L。使用固定或随机效应模型进行荟萃分析。使用纽卡斯尔-渥太华量表评估质量。I 指数用于量化异质性。主要结局是院内死亡率和 30 天死亡率。
八项研究符合荟萃分析的纳入标准，共纳入 4811 例患者（年龄范围，46-91 岁；女性，20-79%）。这些研究专门检查了术前淋巴细胞计数。总体而言，这些研究的质量为中等到高，使用纽卡斯尔-渥太华量表评分>7。术前淋巴细胞减少与死亡率增加三倍相关（风险比 [RR]=3.22；95%置信区间 [CI]，2.19-4.72；P<0.01，I=0%），并且更频繁发生主要术后并发症（RR=1.33；95% CI，1.21-1.45；P<0.01，I=6%），包括心血管发病率（RR=1.77；95% CI，1.45-2.15；P<0.01，I=0%）、感染（RR=1.45；95% CI，1.19-1.76；P<0.01，I=0%）和急性肾功能障碍（RR=2.66；95% CI，1.49-4.77；P<0.01，I=1%）。
术前淋巴细胞减少与死亡和并发症的发生更为相关，独立于手术类型。
PROSPERO 注册号：CRD42020190702。
