Molecular Pathology Unit, Cancer Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Shah Alam 40170, Selangor, Malaysia.
Asia Metropolitan University, Bandar Baru Seri Alam, Johor Bahru 81750, Johor, Malaysia.
Int J Clin Pract. 2023 Jan 31;2023:1068000. doi: 10.1155/2023/1068000. eCollection 2023.
Epstein-Barr virus (EBV) reactivation in acute-phase of COVID-19 disease was recently discovered but it is not clear in terms of degree of mortality caused, and this was the aim of the current study. Six databases and three non-databases were thoroughly searched, independently. The articles related to non-human study (abstract, , , , case study, poster, and review articles) were excluded for main analysis. Four articles related to mortality linked to EBV reactivation were systematically identified and included in the qualitative and quantitative analyses. Based on proportional meta-analysis of 4 studies, 34.3% or 0.343 (95% CI: 0.189-0.516; = 74.6) mortality related to EBV reactivation was identified. To address high heterogeneity, subgroup meta-analysis was carried out. Based on subgroup analysis, 26.6% or 0.266 (95% CI: 0.191-0.348; = 0) with no heterogeneity was identified. Interestingly, in comparative meta-analysis, EBV(-)/SARS-CoV-2(+) patients had statistically lesser mortality (9.9%) than EBV(+)/SARS-CoV-2(+) patients (23.6%) where RR = 2.31 (95% CI: 1.34-3.99; = 0.003; = 6%). This finding is equivalent to the absolute mortality effect of 130 more per 1000 COVID-19 patients (95% CI: 34-296). Furthermore, based on statistical analysis, D-dimer was not statistically significantly different ( > 0.05) between the groups although studies have shown that D-dimer was statistically significantly different ( < 0.05) between these groups. Based on the inclusion and analysis of low risk of bias and high quality of articles graded with Newcastle-Ottawa Scale (NOS), when COVID-19 patients' health state is gradually worsening, EBV reactivation needs to be suspected because EBV reactivation is a possible marker for COVID-19 disease severity.
新型冠状病毒肺炎（COVID-19）疾病急性期的 EBV 再激活最近被发现，但它对死亡率的影响程度尚不清楚，这是本研究的目的。我们彻底检索了 6 个数据库和 3 个非数据库。主要分析排除了与非人类研究相关的文章（摘要、会议记录、病例报告、海报和综述文章）。系统地确定了 4 篇与 EBV 再激活相关的死亡率相关的文章，并将其纳入定性和定量分析。基于 4 项研究的比例荟萃分析，确定与 EBV 再激活相关的死亡率为 34.3%或 0.343（95%CI：0.189-0.516； = 74.6）。为了解决高度异质性问题，进行了亚组荟萃分析。基于亚组分析，确定无异质性的 26.6%或 0.266（95%CI：0.191-0.348； = 0）。有趣的是，在比较荟萃分析中，EBV(-)/SARS-CoV-2(+)患者的死亡率（9.9%）明显低于 EBV(+)/SARS-CoV-2(+)患者（23.6%），RR = 2.31（95%CI：1.34-3.99； = 0.003； = 6%）。这一发现相当于每 1000 例 COVID-19 患者有 130 例额外的绝对死亡率（95%CI：34-296）。此外，基于统计学分析，尽管研究表明 D-二聚体在这些组之间具有统计学上的显著差异（ < 0.05），但两组之间的 D-二聚体没有统计学上的显著差异（ > 0.05）。基于低偏倚风险和使用纽卡斯尔-渥太华量表（NOS）进行的高质量文章的纳入和分析，当 COVID-19 患者的健康状况逐渐恶化时，应怀疑 EBV 再激活，因为 EBV 再激活可能是 COVID-19 疾病严重程度的一个标志物。
