Lowden Rachel, Turner Steve
Child Health, University of Aberdeen, Aberdeen, UK.
Paediatric Dept, NHS Grampian, Aberdeen, UK.
ERJ Open Res. 2022 Nov 14;8(4). doi: 10.1183/23120541.00174-2022. eCollection 2022 Oct.
Acute exacerbations are common in children and potentially preventable. Currently, a past exacerbation is the best predictor of a future exacerbation. We undertook a systematic review of the literature describing the relationship between past and future exacerbations. Our analysis considered whether the odds ratios for one exacerbation to predict a recurrence were different across different categories of exacerbation. Four databases were searched systematically (MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health and PsycInfo). Exacerbations were categorised by severity as: presentation to emergency department (ED); hospital admission; paediatric intensive care unit (PICU) admission; and "unspecified severity" ( no distinction between severity categories was made). Meta-analysis was performed for studies where sufficient data were provided for inclusion. There were 26 eligible articles from 9185 identified. There was significant heterogeneity in duration of follow-up, healthcare system and exacerbation definition between studies. For the unspecified severity definition, the odds ratio for an exacerbation after a previous exacerbation was 9.87 (95% CI 5.02-19.39; six studies, 162 583 individuals). PICU admission was also associated with increased risk of future admission (OR 5.87, 95% CI 2.96-11.64; two studies, 730 individuals). Meta-analysis was not possible for ED visits or hospitalisation. The median odds ratio (range) for past ED visit predicting future ED visit was 6.27 (3.3-8.26) and for past hospitalisation predicting future hospitalisation was 3.37 (1.89-5.36). The odds for a second asthma exacerbation do not necessarily increase with increasing severity of an initial exacerbation.
急性加重在儿童中很常见，且有可能预防。目前，既往加重是未来加重的最佳预测指标。我们对描述既往加重与未来加重之间关系的文献进行了系统综述。我们的分析考虑了一次加重预测复发的比值比在不同加重类别中是否不同。系统检索了四个数据库（MEDLINE、Embase、护理及相关健康累积索引和PsycInfo）。加重按严重程度分类为：急诊就诊；住院；儿科重症监护病房（PICU）住院；以及“未明确严重程度”（未区分严重程度类别）。对提供了足够数据以供纳入的研究进行了荟萃分析。从9185篇文献中筛选出26篇符合条件的文章。各研究在随访时间、医疗系统和加重定义方面存在显著异质性。对于未明确严重程度的定义，既往加重后再次加重的比值比为9.87（95%CI 5.02 - 19.39；六项研究，162583人）。PICU住院也与未来住院风险增加相关（OR 5.87，95%CI 2.96 - 11.64；两项研究，730人）。对于急诊就诊或住院无法进行荟萃分析。既往急诊就诊预测未来急诊就诊的中位数比值比（范围）为6.27（3.3 - 8.26），既往住院预测未来住院的中位数比值比为3.37（1.89 - 5.36）。第二次哮喘加重的几率不一定随初始加重严重程度的增加而增加。
