中国成年人脓毒症的患病率：系统评价和荟萃分析。
Prevalence of sepsis among adults in China: A systematic review and meta-analysis.
机构信息
Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China.
College of Basic Medical Science, Institute of Basic Research in Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
出版信息
Front Public Health. 2022 Oct 11;10:977094. doi: 10.3389/fpubh.2022.977094. eCollection 2022.
BACKGROUND
Sepsis is a major public health problem that cannot be ignored in China and even in the world. However, the prevalence of sepsis in Chinese adults varies among different studies.
OBJECTIVE
To evaluate the prevalence of hospital-wide sepsis and intensive care unit (ICU) sepsis in Chinese adults.
METHODS
PubMed, EMBASE, Cochrane Library, Web of science, China National Knowledge Infrastructure, Chinese biomedical literature service system, Wanfang Database, and VIP databases were systematically searched for studies on sepsis in China published before March 2, 2022. Random effects model was used to calculate pooled prevalence estimates with 95% confidence interval. Subgroup and sensitivity analyses were performed to address heterogeneity. Funnel plots and Egger's test were used to assess the publication bias.
RESULTS
Overall, nine observational studies involving 324,020 Chinese patients (9,587 patients with sepsis) were analyzed. Four hospital-wide studies involving 301,272 patients showed pooled prevalence and mortality of 3.8% (95% CI: 2.9-4.7%, = 99.9%) and 26% (95% CI: 16-36%, = 98.0%), respectively. Five studies of ICU sepsis involving 22,748 patients presented pooled prevalence and mortality of 25.5% (95% CI: 13.9-37.0%, = 99.8%) and 40% (95%CI: 34-47%, = 95.9%), respectively. Subgroup analysis of sepsis in ICUs revealed that the pooled prevalence was higher among males [17% (95% CI 9-24%, = 99.6%)], in lung infections [66% (95%CI: 54-77%, = 98.7%)], and Gram-negative bacteria infections [37% (95%CI: 26-47%, = 98.3%)]. The pooled prevalence of sepsis, severe sepsis and septic shock was 25.5% (95%CI: 13.9-37.0%, = 99.8%), 19% (95%CI: 9-28%, = 99.6%), and 13% (95%CI: 7-19%, = 99.2%), respectively.
CONCLUSIONS
Sepsis is prevalent in 25.5% of ICU patients in China, and sex, sepsis severity, infection site, causative microorganism, and infection type are significant influencing factors. Larger trials are needed to evaluate the prevalence of sepsis in China, which may help the development of global strategies for sepsis management.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier: CRD42022314274.
背景
脓毒症是中国乃至全球不可忽视的重大公共卫生问题。然而，不同研究中中国成年人脓毒症的患病率存在差异。
目的
评估中国成年人全人群脓毒症和重症监护病房（ICU）脓毒症的患病率。
方法
系统检索 PubMed、EMBASE、Cochrane 图书馆、Web of Science、中国知网、中国生物医学文献服务系统、万方数据库和维普数据库，收集截至 2022 年 3 月 2 日前在中国发表的关于脓毒症的研究。采用随机效应模型计算合并患病率及其 95%置信区间。进行亚组和敏感性分析以解决异质性问题。采用漏斗图和 Egger 检验评估发表偏倚。
结果
共纳入 9 项观察性研究，涉及 324020 例中国患者（9587 例脓毒症患者）。4 项全人群脓毒症研究共纳入 301272 例患者，合并患病率和死亡率分别为 3.8%（95%CI：2.9%-4.7%， = 99.9%）和 26%（95%CI：16%-36%， = 98.0%）。5 项 ICU 脓毒症研究共纳入 22748 例患者，合并患病率和死亡率分别为 25.5%（95%CI：13.9%-37.0%， = 99.8%）和 40%（95%CI：34%-47%， = 95.9%）。ICU 脓毒症亚组分析显示，男性[17%（95%CI：9%-24%， = 99.6%）]、肺部感染[66%（95%CI：54%-77%， = 98.7%）]和革兰阴性菌感染[37%（95%CI：26%-47%， = 98.3%）]患者的合并患病率较高。脓毒症、严重脓毒症和脓毒性休克的合并患病率分别为 25.5%（95%CI：13.9%-37.0%， = 99.8%）、19%（95%CI：9%-28%， = 99.6%）和 13%（95%CI：7%-19%， = 99.2%）。
结论
中国 ICU 患者中脓毒症的患病率为 25.5%，性别、脓毒症严重程度、感染部位、病原体和感染类型是显著的影响因素。需要更大规模的试验来评估中国脓毒症的患病率，这可能有助于制定全球脓毒症管理策略。
系统评价注册
PROSPERO，注册号：CRD42022314274。
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