髋部骨折患者医院获得性肺炎的危险因素：系统评价和荟萃分析。

Risk factors for hospital-acquired pneumonia in hip fracture patients: A systematic review and meta-analysis.

机构信息

Department of Orthopedics, Dandong Central Hospital, China Medical University, Dandong, China.

Department of Pediatrics, Dandong Central Hospital, China Medical University, Dandong, China.

出版信息

Medicine (Baltimore). 2024 Mar 8;103(10):e35773. doi: 10.1097/MD.0000000000035773.

DOI:10.1097/MD.0000000000035773

PMID:38457536

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10919500/

Abstract

BACKGROUND

This study aimed to comprehensively assess the prevalence and risk factors for Hospital-acquired pneumonia (HAP) in hip fracture patients by meta-analysis.

METHODS

Systematically searched 4 English databases and 4 Chinese databases from inception until October 20, 2022. All studies involving risk factors of HAP in patients with hip fractures will be considered. Newcastle-Ottawa Scale was used to evaluate the quality of the included studies. The results were presented through Review Manager 5.4 with the pooled odds ratio (OR) and 95% confidence interval.

RESULTS

Of 35 articles included in this study, the incidence of HAP was 8.9%. 43 risk factors for HAP were initially included, 23 were eventually involved in the meta-analysis, and 21 risk factors were significant. Among them, the 4 most frequently mentioned risk factors were as follows: Advanced age (OR 1.07, 95% CI 1.05-1.10), chronic obstructive pulmonary disease (COPD) (OR 3.44, 95% CI 2.83-4.19), time from injury to operation (OR 1.09, 95% CI 1.07-1.12), time from injury to operation ≥ 48 hours (OR 3.59, 95% CI 2.88-4.48), and hypoalbuminemia < 3.5g/dL (OR 2.68, 95% CI 2.15-3.36).

DISCUSSION

Hip fracture patients diagnosed with COPD have a 3.44 times higher risk of HAP compared to the general hip fracture patients. The risk of HAP also increases with age, with patients over 70 having a 2.34-fold higher risk and those over 80 having a 2.98-fold higher risk. These findings highlight the need for tailored preventive measures and timely interventions in vulnerable patient populations. Additionally, hip fracture patients who wait more than 48 hours for surgery have a 3.59-fold higher incidence of HAP. This emphasizes the importance of swift surgical intervention to minimize HAP risk. However, there are limitations to consider in this study, such as heterogeneity in selected studies, inclusion of only factors identified through multivariate logistic regression, and the focus on non-randomized controlled trial studies.

摘要

背景

本研究旨在通过荟萃分析全面评估髋部骨折患者医院获得性肺炎（HAP）的患病率和危险因素。

方法

系统检索了 4 个英文数据库和 4 个中文数据库，检索时间截至 2022 年 10 月 20 日。所有涉及髋部骨折患者 HAP 危险因素的研究都将被考虑。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）来评估纳入研究的质量。结果通过 Review Manager 5.4 呈现，汇总了比值比（OR）和 95%置信区间。

结果

本研究共纳入 35 篇文章，HAP 的发生率为 8.9%。最初纳入了 43 个 HAP 危险因素，最终有 23 个纳入了荟萃分析，其中 21 个危险因素有统计学意义。其中，最常提到的 4 个危险因素如下：高龄（OR 1.07，95%CI 1.05-1.10）、慢性阻塞性肺疾病（COPD）（OR 3.44，95%CI 2.83-4.19）、受伤至手术时间（OR 1.09，95%CI 1.07-1.12）、受伤至手术时间≥48 小时（OR 3.59，95%CI 2.88-4.48）和低白蛋白血症＜3.5g/dL（OR 2.68，95%CI 2.15-3.36）。

讨论

与一般髋部骨折患者相比，诊断为 COPD 的髋部骨折患者发生 HAP 的风险高 3.44 倍。随着年龄的增长，HAP 的风险也会增加，70 岁以上的患者发生 HAP 的风险增加 2.34 倍，80 岁以上的患者发生 HAP 的风险增加 2.98 倍。这些发现强调了在脆弱的患者群体中需要采取有针对性的预防措施和及时干预。此外，髋部骨折患者等待手术时间超过 48 小时，HAP 的发生率增加 3.59 倍。这强调了迅速进行手术干预以降低 HAP 风险的重要性。然而，在这项研究中存在一些局限性，例如所选研究的异质性、仅纳入多变量逻辑回归确定的因素以及侧重于非随机对照试验研究。