脓毒症幸存者患痴呆或认知障碍的风险：一项系统评价和荟萃分析。
Risk of Dementia or Cognitive Impairment in Sepsis Survivals: A Systematic Review and Meta-Analysis.
作者信息
Lei Siyuan, Li Xuanlin, Zhao Hulei, Feng Zhenzhen, Chun Liu, Xie Yang, Li Jiansheng
机构信息
Department of Respiratory Diseases, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China.
出版信息
Front Aging Neurosci. 2022 Mar 9;14:839472. doi: 10.3389/fnagi.2022.839472. eCollection 2022.
BACKGROUND
There is growing evidence that sepsis survivors are at increased risk of developing new-onset atrial fibrillation, acute kidney injury, and neurological diseases. However, whether sepsis survivals increase the risk of dementia or cognitive impairment remains to be further explored.
OBJECTIVE
The objective of this study was to determine whether sepsis survivals increase the risk of dementia or cognitive impairment.
METHODS
We searched PubMed, Cochrane Library, Web of Science, and EMBASE databases for cohort studies or case-control studies from their inception to November 5, 2021. The quality of this study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). The Stata software (version 15.1) was used to calculate the odds ratio (OR) of dementia or cognitive impairment in sepsis survivals. Subgroup and sensitivity analyses were performed to assess the source of heterogeneity. Funnel plots and Egger's test were used to detect the publication bias.
RESULTS
Eight studies (i.e., seven cohort studies and one case-control study) involving 891,562 individuals were included. The quality assessment results showed that the average score of NOS was over 7, and the overall quality of the included studies was high. Pooled analyses indicated that sepsis survivals were associated with an increased risk of all-cause dementia (OR = 1.62, 95% CI = 1.23-2.15, = 96.4%, = 0.001). However, there was no obvious association between sepsis survivals and the risk of cognitive impairment (OR = 1.77, 95% CI = 0.59-5.32, = 87.4%, = 0.306). Subgroup analyses showed that severe sepsis was associated with an increased risk of dementia or cognitive impairment (OR = 1.99, 95% CI = 1.19-3.31, = 75.3%, = 0.008); such risk was higher than that of other unspecified types of sepsis (OR = 1.47, 95% CI = 1.04-2.09, = 97.6%, = 0.029).
CONCLUSION
Sepsis survivals are associated with an increased risk of all-cause dementia but not with cognitive impairment. Appropriate management and prevention are essential to preserve the cognitive function of sepsis survivors and reduce the risk of dementia.
背景
越来越多的证据表明，脓毒症幸存者发生新发房颤、急性肾损伤和神经系统疾病的风险增加。然而，脓毒症幸存者是否会增加患痴呆症或认知障碍的风险仍有待进一步探索。
目的
本研究的目的是确定脓毒症幸存者是否会增加患痴呆症或认知障碍的风险。
方法
我们检索了PubMed、Cochrane图书馆、Web of Science和EMBASE数据库，以查找从数据库建立至2021年11月5日的队列研究或病例对照研究。本研究的质量使用纽卡斯尔-渥太华质量评估量表（NOS）进行评估。使用Stata软件（版本15.1）计算脓毒症幸存者患痴呆症或认知障碍的比值比（OR）。进行亚组分析和敏感性分析以评估异质性来源。使用漏斗图和Egger检验来检测发表偏倚。
结果
纳入了八项研究（即七项队列研究和一项病例对照研究），涉及891,562人。质量评估结果显示，NOS的平均得分超过7分，纳入研究的总体质量较高。汇总分析表明，脓毒症幸存者患全因痴呆症的风险增加（OR = 1.62，95%CI = 1.23 - 2.15，I² = 96.4%，P = 0.001）。然而，脓毒症幸存者与认知障碍风险之间无明显关联（OR = 1.77，95%CI = 0.59 - 5.32，I² = 87.4%，P = 0.306）。亚组分析表明，严重脓毒症与痴呆症或认知障碍风险增加相关（OR = 1.99，95%CI = 1.19 - 3.31，I² = 75.3%，P = 0.008）；这种风险高于其他未明确类型的脓毒症（OR = 1.47，95%CI = 1.04 - 2.09，I² = 97.6%，P = 0.029）。
结论
脓毒症幸存者患全因痴呆症的风险增加，但与认知障碍无关。适当的管理和预防对于保护脓毒症幸存者的认知功能和降低痴呆症风险至关重要。
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