Gan Ming Ying, Lee Wen Li, Yap Bei Jun, Seethor Shu Ting Tammie, Greenberg Rachel G, Pek Jen Heng, Tan Bobby, Hornik Christoph Paul Vincent, Lee Jan Hau, Chong Shu-Ling
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
Front Pediatr. 2022 Jun 3;10:890767. doi: 10.3389/fped.2022.890767. eCollection 2022.
Current knowledge on the global burden of infant sepsis is limited to population-level data. We aimed to summarize global case fatality rates (CFRs) of young infants with sepsis, stratified by gross national income (GNI) status and patient-level risk factors.
We performed a systematic review and meta-analysis on CFRs among young infants < 90 days with sepsis. We searched PubMed, Cochrane Central, Embase, and Web of Science for studies published between January 2010 and September 2019. We obtained pooled CFRs estimates using the random effects model. We performed a univariate analysis at patient-level and a meta-regression to study the associations of gestational age, birth weight, onset of sepsis, GNI, age group and culture-proven sepsis with CFRs.
The search yielded 6314 publications, of which 240 studies ( = 437,796 patients) from 77 countries were included. Of 240 studies, 99 were conducted in high-income countries, 44 in upper-middle-income countries, 82 in lower-middle-income countries, 6 in low-income countries and 9 in multiple income-level countries. Overall pooled CFR was 18% (95% CI, 17-19%). The CFR was highest for low-income countries [25% (95% CI, 7-43%)], followed by lower-middle [25% (95% CI, 7-43%)], upper-middle [21% (95% CI, 18-24%)] and lowest for high-income countries [12% (95% CI, 11-13%)]. Factors associated with high CFRs included prematurity, low birth weight, age less than 28 days, early onset sepsis, hospital acquired infections and sepsis in middle- and low-income countries. Study setting in middle-income countries was an independent predictor of high CFRs. We found a widening disparity in CFRs between countries of different GNI over time.
Young infant sepsis remains a major global health challenge. The widening disparity in young infant sepsis CFRs between GNI groups underscore the need to channel greater resources especially to the lower income regions.
[www.crd.york.ac.uk/prospero], identifier [CRD42020164321].
目前关于全球婴儿败血症负担的知识仅限于人群层面的数据。我们旨在总结按国民总收入（GNI）状况和患者层面风险因素分层的婴儿败血症全球病死率（CFR）。
我们对90日龄以下患败血症的婴儿的CFR进行了系统评价和荟萃分析。我们在PubMed、Cochrane中心、Embase和科学网中检索了2010年1月至2019年9月发表的研究。我们使用随机效应模型获得合并的CFR估计值。我们在患者层面进行了单因素分析和荟萃回归，以研究胎龄、出生体重、败血症发病时间、GNI、年龄组和经培养证实的败血症与CFR的关联。
检索得到6314篇文献，其中纳入了来自77个国家的240项研究（n = 437,796例患者）。在240项研究中，99项在高收入国家进行，44项在上中等收入国家进行，82项在下中等收入国家进行，6项在低收入国家进行，9项在多个收入水平国家进行。总体合并CFR为18%（95%CI，17 - 19%）。低收入国家的CFR最高[25%（95%CI，7 - 43%）]，其次是下中等收入国家[25%（95%CI，7 - 43%）]、上中等收入国家[21%（95%CI，18 - 24%）]，高收入国家最低[12%（95%CI，11 - 13%）]。与高CFR相关的因素包括早产、低出生体重、年龄小于28天、早发性败血症、医院获得性感染以及中低收入国家的败血症。中等收入国家的研究环境是高CFR的独立预测因素。我们发现不同GNI国家之间的CFR差距随时间不断扩大。
婴儿败血症仍然是一项重大的全球健康挑战。GNI组之间婴儿败血症CFR差距不断扩大，凸显了需要将更多资源尤其是投入到低收入地区的必要性。
