非新冠肺炎社区获得性肺炎患者中抗血小板药物与死亡率的关联：一项系统评价和荟萃分析
The association of antiplatelet agents with mortality among patients with non-COVID-19 community-acquired pneumonia: a systematic review and meta-analysis.
作者信息
Lother Sylvain A, Tennenhouse Lana, Rabbani Rasheda, Abou-Setta Ahmed M, Askin Nicole, Turgeon Alexis F, Murthy Srinivas, Houston Brett L, Houston Donald S, Mendelson Asher A, Paul Jonathan D, Farkouh Michael E, Hasmatali Jovan, Rush Barret, Nkosi Joel, Goligher Ewan C, Rimmer Emily, Marshall John C, Shaw Souradet Y, Lawler Patrick R, Keynan Yoav, Zarychanski Ryan
机构信息
Section of Infectious Diseases, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Section of Critical Care, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
出版信息
Res Pract Thromb Haemost. 2024 Jul 22;8(5):102526. doi: 10.1016/j.rpth.2024.102526. eCollection 2024 Jul.
BACKGROUND
Community-acquired pneumonia (CAP) triggers inflammatory and thrombotic host responses driving morbidity and mortality. Antiplatelet agents may favorably modulate these pathways; however, their role in non-COVID-19 CAP remains uncertain.
OBJECTIVES
To evaluate the association of antiplatelet agents with mortality in hospitalized patients with non-COVID-19 CAP.
METHODS
We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs) of adult patients hospitalized for non-COVID-19 CAP exposed to antiplatelet agents (acetylsalicylic acid or P2Y12 inhibitors). We searched MEDLINE, Embase, and CENTRAL from inception to August 2023. Our primary outcome was all-cause mortality: meta-analyzed (random-effects models) separately for observational studies and RCTs. For observational studies, we used adjusted mortality estimates.
RESULTS
We included 13 observational studies (123,012 patients; 6 reported adjusted mortality estimates) and 2 RCTs (225 patients; both high risk of bias). In observational studies reporting hazard ratio, antiplatelet agents were associated with lower mortality (hazard ratio, 0.65; 95% CI, 0.46-0.91; = 85%; 4 studies, 91,430 patients). In studies reporting adjusted odds ratio, antiplatelet agent exposure was associated with reduced odds of mortality (odds ratio, 0.67; 95% CI, 0.45-1.00; = 0%; 2 studies, 24,889 patients). Among RCTs, there was a nonsignificant association with mortality (risk ratio, 0.66; 95% CI, 0.20-2.25; = 54%; 2 studies, 225 patients). By the Grading of Recommendations, Assessment, Development, and Evaluation criteria, the certainty of the evidence was low, primarily due to risk of bias.
CONCLUSION
In hospitalized patients with non-COVID-19 CAP, antiplatelet agents may be associated with reduced mortality compared with usual care or placebo, but the certainty of evidence is low.
背景
社区获得性肺炎（CAP）引发炎症和血栓形成的宿主反应，导致发病和死亡。抗血小板药物可能对这些途径产生有利调节作用；然而，它们在非COVID-19 CAP中的作用仍不确定。
目的
评估抗血小板药物与非COVID-19 CAP住院患者死亡率之间的关联。
方法
我们对因非COVID-19 CAP住院的成年患者使用抗血小板药物（阿司匹林或P2Y12抑制剂）的观察性研究和随机对照试验（RCT）进行了系统评价和荟萃分析。我们检索了从数据库建立至2023年8月的MEDLINE、Embase和CENTRAL数据库。我们的主要结局是全因死亡率：分别对观察性研究和RCT进行荟萃分析（随机效应模型）。对于观察性研究，我们使用调整后的死亡率估计值。
结果
我们纳入了13项观察性研究（123,012例患者；6项报告了调整后的死亡率估计值）和2项RCT（225例患者；均存在高偏倚风险）。在报告风险比的观察性研究中，抗血小板药物与较低的死亡率相关（风险比，0.65；95%CI，0.46 - 0.91；I² = 85%；4项研究，91,430例患者）。在报告调整后的比值比的研究中，使用抗血小板药物与死亡几率降低相关（比值比，0.67；95%CI，0.45 - 1.00；I² = 0%；2项研究，24,889例患者）。在RCT中，与死亡率的关联不显著（风险比，0.66；95%CI，0.20 - 2.25；I² = 54%；2项研究，225例患者）。根据推荐分级、评估、制定和评价标准，证据的确定性较低，主要是由于存在偏倚风险。
结论
在非COVID-19 CAP住院患者中，与常规治疗或安慰剂相比，抗血小板药物可能与死亡率降低相关，但证据的确定性较低。
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