慢性阻塞性肺疾病中铜绿假单胞菌分离的危险因素：系统评价和荟萃分析。

Risk factors for Pseudomonas aeruginosa isolation in chronic obstructive pulmonary disease: a systematic review and meta-analysis.

机构信息

Department of General Practice, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi , 710032, China.

Department of Pediatrics, The Second Hospital of Yulin, Yulin, Shaanxi, 719000, China.

出版信息

BMC Pulm Med. 2024 Oct 18;24(1):521. doi: 10.1186/s12890-024-03309-x.

DOI:10.1186/s12890-024-03309-x

PMID:39425103

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11487921/

Abstract

BACKGROUND

Pseudomonas aeruginosa (PA) isolation in patients with chronic obstructive pulmonary disease (COPD) has been associated with a poor prognosis. This meta-analysis aimed to determine significant risk factors for PA isolation among patients with COPD.

METHODS

A systematic literature retrieval from PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) was conducted, including studies from January 2003 to September 2024. Case-control and cohort studies exploring the risk factors for PA isolation in patients with COPD were included in this analysis. A random-effects model was applied to estimate the pooled adjusted odds ratio (paOR) or hazard ratio (paHR) with the corresponding 95% confidence intervals (CI).

RESULTS

Thirteen eligible studies with a total of 25,802 participants were included in this meta-analysis. Prior systemic steroid therapy (paOR: 2.67; 95% CI: 1.29-5.53; P = 0.008), previous antibiotic treatment (paOR: 2.83; 95% CI: 1.14-6.97; P = 0.02), high "Body mass index, airflow Obstruction, Dyspnea, Exercise capacity" (BODE) index (paOR: 4.13; 95% CI: 1.67-10.23; P = 0.002), 6-min walking distance (6MWD) < 250 m (paOR: 4.27; 95% CI: 2.59-7.01; P < 0.001), COPD assessment test (CAT) score > 20 points (paOR: 2.49; 95% CI: 1.46-4.23; P = 0.001), hypoproteinemia (paOR: 2.62; 95%CI: 1.32-5.19; P = 0.006), hospitalizations in the previous year (paOR: 3.74; 95%CI: 1.22-11.49; P = 0.021), Bronchiectasis (paOR = 4.81; 95% CI: 3.66-6.33; P < 0.001) and prior PA isolation (paOR: 16.39; 95% CI: 7.65-35.10; P < 0.001) were associated with PA isolation in patients with COPD.

CONCLUSIONS

Our study identified nine risk factors associated with an increased risk of PA isolation in COPD patients. These findings are significant for the early identification of patients at risk for PA isolation, which might contribute to reducing mortality and improving clinical outcomes.

摘要

背景

铜绿假单胞菌（PA）在慢性阻塞性肺疾病（COPD）患者中的分离与预后不良有关。本荟萃分析旨在确定 COPD 患者中 PA 分离的显著危险因素。

方法

从 PubMed、Embase、Web of Science 和中国国家知识基础设施（CNKI）进行系统文献检索，包括 2003 年 1 月至 2024 年 9 月的研究。纳入了探索 COPD 患者中 PA 分离危险因素的病例对照和队列研究。采用随机效应模型估计合并调整后的优势比（paOR）或风险比（paHR）及其相应的 95%置信区间（CI）。

结果

本荟萃分析纳入了 13 项符合条件的研究，共计 25802 名参与者。先前的全身类固醇治疗（paOR：2.67；95%CI：1.29-5.53；P=0.008）、先前的抗生素治疗（paOR：2.83；95%CI：1.14-6.97；P=0.02）、高“体重指数、气流阻塞、呼吸困难、运动能力”（BODE）指数（paOR：4.13；95%CI：1.67-10.23；P=0.002）、6 分钟步行距离（6MWD）<250 m（paOR：4.27；95%CI：2.59-7.01；P<0.001）、COPD 评估测试（CAT）评分>20 分（paOR：2.49；95%CI：1.46-4.23；P=0.001）、低蛋白血症（paOR：2.62；95%CI：1.32-5.19；P=0.006）、前一年住院（paOR：3.74；95%CI：1.22-11.49；P=0.021）、支气管扩张（paOR=4.81；95%CI：3.66-6.33；P<0.001）和既往 PA 分离（paOR：16.39；95%CI：7.65-35.10；P<0.001）与 COPD 患者中 PA 分离相关。