糖尿病重症患者的侵袭性曲霉病：一项系统评价和荟萃分析。

Invasive aspergillosis in critically ill patients with diabetes mellitus: a systematic review and meta-analysis.

作者信息

Liu Yuhua, Zhang Zhaopei, Zhou Liang, Lin Tianlai, Zhang Rong, Li Manshu, Chen Sihao, Liu Xiaoqing, Liu Xuesong

机构信息

State Key Lab of Respiratory Diseases, Guangzhou Institute of Respiratory Health, Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Street West, Guangzhou, 510120, Guangdong, China.

Department of Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.

出版信息

BMC Infect Dis. 2025 Jan 30;25(1):141. doi: 10.1186/s12879-025-10560-y.

DOI:10.1186/s12879-025-10560-y

PMID:39885384

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11783785/

Abstract

BACKGROUND

In the intensive care unit (ICU), invasive aspergillosis (IA) has a poor prognosis. Some studies report a positive association between diabetes mellitus (DM) and IA in critically ill patients, but the relationship between DM and IA in the ICU remains controversial. We aimed to clarify the relationship between DM and IA among patients in the ICU in a systematic review and meta-analysis.

METHODS

We retrieved all reports published in PubMed, EMBASE, and the Cochrane Library databases before July 12, 2023. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the relationship between DM and IA. Subgroup analyses were conducted to further analyze sources of heterogeneity. Heterogeneity was evaluated using the Cochran's Q test and I statistic. Additionally, we evaluated publication bias using funnel plots, Egger's test, and Begg's test. Finally, sensitivity analysis was conducted to evaluate the robustness of the results.

RESULTS

Twenty studies with 6155 participants were included in this meta-analysis. We found a positive association between DM and IA among patients in the ICU (OR = 1.18, 95% CI:1.01 to 1.39; p = 0.04). The heterogeneity was not significant (I² = 5%; p = 0.39) and publication bias was not significant (Egger's test: p = 0.654; Begg's test: p = 0.417). The results of sensitivity analysis supported a stable association between DM and IA. Subgroup analysis indicated that patients' comorbidities might be a potential source of heterogeneity. Additionally, patients with DM had a significantly higher risk of COVID-19-associated pulmonary aspergillosis (CAPA) than those without DM (OR = 1.40, 95% CI: 1.15 to 1.70; p < 0.001). The heterogeneity was not significant (I² = 0%; p = 0.91). In the subgroup with influenza, the OR of the relationship between DM and IA was 0.81 (95% CI: 0.54, 1.23; p = 0.32; heterogeneity: p = 0.36; I² = 8%).

CONCLUSIONS

Patients with DM in the ICU showed a higher risk of developing IA than patients in the ICU without DM. DM was a significant risk factor for IA, with the highest risk observed in critically ill patients diagnosed with CAPA.

摘要

背景

在重症监护病房（ICU）中，侵袭性曲霉病（IA）的预后较差。一些研究报告称，危重症患者中糖尿病（DM）与IA之间存在正相关，但ICU中DM与IA的关系仍存在争议。我们旨在通过系统评价和荟萃分析来阐明ICU患者中DM与IA之间的关系。

方法

我们检索了2023年7月12日前在PubMed、EMBASE和Cochrane图书馆数据库中发表的所有报告。我们计算比值比（OR）和95%置信区间（CI）来评估DM与IA之间的关系。进行亚组分析以进一步分析异质性来源。使用Cochran's Q检验和I统计量评估异质性。此外，我们使用漏斗图、Egger检验和Begg检验评估发表偏倚。最后，进行敏感性分析以评估结果的稳健性。

结果

本荟萃分析纳入了20项研究，共6155名参与者。我们发现ICU患者中DM与IA之间存在正相关（OR = 1.18，95% CI：1.01至1.39；p = 0.04）。异质性不显著（I² = 5%；p = 0.39），发表偏倚也不显著（Egger检验：p = 0.654；Begg检验：p = 0.417）。敏感性分析结果支持DM与IA之间存在稳定的关联。亚组分析表明，患者的合并症可能是异质性的一个潜在来源。此外，DM患者发生新型冠状病毒肺炎相关肺曲霉病（CAPA）的风险显著高于非DM患者（OR = 1.40，95% CI：1.15至1.70；p < 0.001）。异质性不显著（I² = 0%；p = 0.91）。在流感亚组中，DM与IA关系的OR为0.81（95% CI：0.54，1.23；p = 0.32；异质性：p = 0.36；I² = 8%）。