成人多发伤患者多器官衰竭的发生率：系统评价和荟萃分析。
Incidence of multiple organ failure in adult polytrauma patients: A systematic review and meta-analysis.
机构信息
From the St George and Sutherland Clinical School, Faculty of Medicine, University of New South Wales (R.S.T., K.X.Y., T.A.N.), Sydney; Department of Traumatology, Division of Surgery, John Hunter Hospital, Hunter Medical Research Institute (D.P.L., K.K., Z.J.B.), University of Newcastle, Newcastle; New South Wales Institute of Trauma and Injury Management Agency for Clinical Innovation; (P.S., M.D.) Department of Acute Care Surgery, Liverpool Hospital (L.D.); School of Medicine, The University of Notre Dame (S.H.); Faculty of Health, University of Technology Sydney (C.L.); Department of Traumatology, Royal North Shore Hospital (M.S.); Department of Traumatology, Concord Repatriation General Hospital (W.R.); and Emergency Care Institute, Agency for Clinical Innovation (H.A.), Sydney, New South Wales, Australia.
出版信息
J Trauma Acute Care Surg. 2023 May 1;94(5):725-734. doi: 10.1097/TA.0000000000003923. Epub 2023 Feb 21.
BACKGROUND
Postinjury multiple organ failure (MOF) is the leading cause of late death in trauma patients. Although MOF was first described 50 years ago, its definition, epidemiology, and change in incidence over time are poorly understood. We aimed to describe the incidence of MOF in the context of different MOF definitions, study inclusion criteria, and its change over time.
METHODS
Cochrane Library, EMBASE, MEDLINE, PubMed, and Web of Science databases were searched for articles published between 1977 and 2022 in English and German. Random-effects meta-analysis was performed when applicable.
RESULTS
The search returned 11,440 results, of which 842 full-text articles were screened. Multiple organ failure incidence was reported in 284 studies that used 11 unique inclusion criteria and 40 MOF definitions. One hundred six studies published from 1992 to 2022 were included. Weighted MOF incidence by publication year fluctuated from 11% to 56% without significant decrease over time. Multiple organ failure was defined using four scoring systems (Denver, Goris, Marshall, Sequential Organ Failure Assessment [SOFA]) and 10 different cutoff values. Overall, 351,942 trauma patients were included, of whom 82,971 (24%) developed MOF. The weighted incidences of MOF from meta-analysis of 30 eligible studies were as follows: 14.7% (95% confidence interval [CI], 12.1-17.2%) in Denver score >3, 12.7% (95% CI, 9.3-16.1%) in Denver score >3 with blunt injuries only, 28.6% (95% CI, 12-45.1%) in Denver score >8, 25.6% (95% CI, 10.4-40.7%) in Goris score >4, 29.9% (95% CI, 14.9-45%) in Marshall score >5, 20.3% (95% CI, 9.4-31.2%) in Marshall score >5 with blunt injuries only, 38.6% (95% CI, 33-44.3%) in SOFA score >3, 55.1% (95% CI, 49.7-60.5%) in SOFA score >3 with blunt injuries only, and 34.8% (95% CI, 28.7-40.8%) in SOFA score >5.
CONCLUSION
The incidence of postinjury MOF varies largely because of lack of a consensus definition and study population. Until an international consensus is reached, further research will be hindered.
LEVEL OF EVIDENCE
Systematic Review and Meta-analysis; Level III.
背景
创伤后多器官功能衰竭（MOF）是创伤患者晚期死亡的主要原因。尽管 MOF 是 50 年前首次描述的，但它的定义、流行病学以及随时间变化的发病率仍知之甚少。我们旨在描述不同 MOF 定义、研究纳入标准以及随时间变化的 MOF 发病率。
方法
检索了 Cochrane Library、EMBASE、MEDLINE、PubMed 和 Web of Science 数据库中 1977 年至 2022 年间以英文和德文发表的文章。当适用时，进行了随机效应荟萃分析。
结果
搜索结果返回了 11440 条结果，其中筛选了 842 篇全文文章。284 项研究报告了多器官衰竭的发病率，这些研究使用了 11 种独特的纳入标准和 40 种 MOF 定义。共有 106 项发表于 1992 年至 2022 年的研究被纳入。按发表年份加权的 MOF 发病率从 11%波动到 56%，但随时间推移无显著下降。MOF 采用四个评分系统（丹佛、戈里斯、马歇尔、序贯器官衰竭评估 [SOFA]）和 10 个不同的截断值进行定义。总体而言，纳入了 351942 名创伤患者，其中 82971 名（24%）发生了 MOF。30 项合格研究的荟萃分析中 MOF 的加权发生率如下：丹佛评分>3 为 14.7%（95%置信区间 [CI]，12.1-17.2%），丹佛评分>3 且仅为钝器伤为 12.7%（95%CI，9.3-16.1%），丹佛评分>8 为 28.6%（95%CI，12-45.1%），戈里斯评分>4 为 25.6%（95%CI，10.4-40.7%），马歇尔评分>5 为 29.9%（95%CI，14.9-45%），马歇尔评分>5 且仅为钝器伤为 20.3%（95%CI，9.4-31.2%），SOFA 评分>3 为 38.6%（95%CI，33-44.3%），SOFA 评分>3 且仅为钝器伤为 55.1%（95%CI，49.7-60.5%），SOFA 评分>5 为 34.8%（95%CI，28.7-40.8%）。
结论
创伤后 MOF 的发病率差异很大，因为缺乏共识定义和研究人群。在达成国际共识之前，进一步的研究将受到阻碍。
证据水平
系统评价和荟萃分析；III 级。
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