急性坏死性或重症胰腺炎患者感染性坏死发生的相关预后因素——一项系统评价和荟萃分析
Prognostic factors associated with development of infected necrosis in patients with acute necrotizing or severe pancreatitis-A systematic review and meta-analysis.
作者信息
Tran Alexandre, Fernando Shannon M, Rochwerg Bram, Inaba Kenji, Bertens Kimberly A, Engels Paul T, Balaa Fady K, Kubelik Dalibor, Matar Maher, Lenet Tori I, Martel Guillaume
机构信息
From the Department of Surgery (A.T., K.A.B., F.K.B., D.K., M.M., T.I.L., G.M.), School of Epidemiology and Public Health (A.T., T.I.L., G.M.), Division of Critical Care, Department of Medicine (A.T., S.M.F., D.K.), Department of Emergency Medicine (S.M.F.), University of Ottawa, Ottawa; Department of Medicine (B.R.), Department of Health Research Methods, Evidence, and Impact (B.R.), McMaster University, Hamilton, ON, Canada; Division of Acute Care Surgery, Department of Surgery (K.I.), University of Southern California, Los Angeles, California; Division of General Surgery, Department of Surgery (P.T.E.), and Division of Critical Care, Department of Medicine (P.T.E.), McMaster University, Hamilton, Canada.
出版信息
J Trauma Acute Care Surg. 2022 May 1;92(5):940-948. doi: 10.1097/TA.0000000000003502. Epub 2021 Dec 20.
PURPOSE
Acute pancreatitis is a potentially life-threatening condition with a wide spectrum of clinical presentation and illness severity. An infection of pancreatic necrosis (IPN) results in a more than twofold increase in mortality risk as compared with patients with sterile necrosis. We sought to identify prognostic factors for the development of IPN among adult patients with severe or necrotizing pancreatitis.
METHODS
We conducted this prognostic review in accordance with systematic review methodology guidelines. We searched six databases from inception through March 21, 2021. We included English language studies describing prognostic factors associated with the development of IPN. We pooled unadjusted odds ratio (uOR) and adjusted odds ratios (aOR) for prognostic factors using a random-effects model. We assessed risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the GRADE approach.
RESULTS
We included 31 observational studies involving 5,210 patients. Factors with moderate or higher certainty of association with increased IPN risk include older age (uOR, 2.19; 95% confidence interval [CI], 1.39-3.45, moderate certainty), gallstone etiology (aOR, 2.35; 95% CI, 1.36-4.04, high certainty), greater than 50% necrosis of the pancreas (aOR, 3.61; 95% CI, 2.15-6.04, high certainty), delayed enteral nutrition (aOR, 2.09; 95% CI, 1.26-3.47, moderate certainty), multiple or persistent organ failure (aOR, 11.71; 95% CI, 4.97-27.56, high certainty), and invasive mechanical ventilation (uOR, 12.24; 95% CI, 2.28-65.67, high certainty).
CONCLUSION
This meta-analysis confirms the association between several clinical early prognostic factors and the risk of IPN development among patients with severe or necrotizing pancreatitis. These findings provide the foundation for the development of an IPN risk stratification tool to guide more targeted clinical trials for prevention or early intervention strategies.
LEVEL OF EVIDENCE
Systematic review and meta-analysis, Level IV.
目的
急性胰腺炎是一种可能危及生命的疾病，临床表现和病情严重程度范围广泛。胰腺坏死感染（IPN）与无菌性坏死患者相比，死亡风险增加两倍以上。我们试图确定重度或坏死性胰腺炎成年患者发生IPN的预后因素。
方法
我们按照系统评价方法指南进行了这项预后综述。我们检索了从开始到2021年3月21日的六个数据库。我们纳入了描述与IPN发生相关的预后因素的英文研究。我们使用随机效应模型汇总了预后因素的未调整比值比（uOR）和调整比值比（aOR）。我们使用预后研究质量工具评估偏倚风险，并使用GRADE方法评估证据的确定性。
结果
我们纳入了31项观察性研究，涉及5210名患者。与IPN风险增加具有中等或更高关联确定性的因素包括年龄较大（uOR，2.19；95%置信区间[CI]，1.39 - 3.45，中等确定性）、胆结石病因（aOR，2.35；95%CI，1.36 - 4.04，高确定性）、胰腺坏死超过50%（aOR，3.61；95%CI，2.15 - 6.04，高确定性）、延迟肠内营养（aOR，2.09；95%CI，1.26 - 3.47，中等确定性）、多器官或持续性器官功能衰竭（aOR，11.71；95%CI，4.97 - 27.56，高确定性）以及有创机械通气（uOR，12.24；95%CI，2.28 - 65.67，高确定性）。
结论
这项荟萃分析证实了重度或坏死性胰腺炎患者中几个临床早期预后因素与IPN发生风险之间的关联。这些发现为开发IPN风险分层工具提供了基础，以指导更具针对性的预防或早期干预策略的临床试验。
证据水平
系统评价和荟萃分析，IV级。
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