埃塞俄比亚消化性溃疡穿孔疾病患者的不良结局及其预测因素：系统评价与荟萃分析

Unfavorable outcomes and their predictors in patients treated for perforated peptic ulcer disease in Ethiopia: systematic review and meta-analysis.

作者信息

Endeshaw Destaw, Adal Ousman, Tareke Abiyu Abadi, Kebede Natnael, Delie Amare Mebrat, Bogale Eyob Ketema, Anagaw Tadele Fentabel, Tiruneh Misganaw Guadie, Fenta Eneyew Talie

机构信息

Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia.

Department of Emergency and Critical Care Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia.

出版信息

BMC Gastroenterol. 2025 Apr 12;25(1):248. doi: 10.1186/s12876-025-03865-4.

DOI:10.1186/s12876-025-03865-4

PMID:40221691

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11992735/

Abstract

BACKGROUND

Perforated peptic ulcer (PPU) is a surgical emergency condition associated with substantial mortality and morbidity. Despite scattered studies, there exists a gap in comprehensive evidence on management outcomes of this condition in Ethiopia. Hence, this review aimed to assess the pooled mortality and complication rates along with their predictors in patients treated for PPU.

METHODS

In this review, an extensive search across various electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari was conducted. Additionally, searches were conducted in Google Scholar and online library repositories of Addis Ababa, Hawassa, and Bahir Dar Universities, complemented by manual searches of included studies. Data extraction was performed using Excel and the analysis was done using STATA 17 software. Pooled estimates of mortality and complication rates were determined using a random-effect model, while associated predictors were identified through the analysis using a fixed-effect model. Subgroup analysis for mortality rate was conducted by region. Sensitivity analysis was performed after assessing heterogeneity using the I test, and potential publication bias was examined through funnel plots, along with Egger's and Begg's tests.

RESULTS

This meta-analysis, encompassing 9 studies, revealed a pooled mortality rate of 6.68% (95% CI: 4.36, 9.00) with a high level of heterogeneity (I = 57%) and a complication rate of 23.21% (95% CI: 19.72, 26.69) with a moderate level of heterogeneity (I = 43%) in patients treated for PPU. Notably, presentation after 24 h exhibited 4 times higher odds (95% CI: 1.79-8.95) of developing complications, while low systolic blood pressure (AOR 4.81; 95% CI: 1.75-13.20) was associated with increased complication risk.

CONCLUSION

In Ethiopia, morbidity and mortality following PPU management are significant, influenced by delayed presentation, low systolic blood pressure, and advanced age. Timely interventions, early hemodynamic stabilization, and age-specific considerations are vital to improving outcomes.

PROTOCOL REGISTRATION NUMBER

CRD42024497946.

摘要

背景

穿孔性消化性溃疡（PPU）是一种外科急症，与较高的死亡率和发病率相关。尽管有一些分散的研究，但埃塞俄比亚关于这种疾病管理结果的综合证据存在差距。因此，本综述旨在评估PPU治疗患者的合并死亡率和并发症发生率及其预测因素。

方法

在本综述中，对包括PubMed、非洲医学索引、科学Direct和Hinari在内的各种电子数据库进行了广泛搜索。此外，还在谷歌学术以及亚的斯亚贝巴大学、哈瓦萨大学和巴赫达尔大学的在线图书馆存储库中进行了搜索，并对纳入研究进行了手工搜索。使用Excel进行数据提取，并使用STATA 17软件进行分析。使用随机效应模型确定死亡率和并发症发生率的合并估计值，同时通过固定效应模型分析确定相关预测因素。按地区进行死亡率的亚组分析。在使用I检验评估异质性后进行敏感性分析，并通过漏斗图以及Egger检验和Begg检验检查潜在的发表偏倚。

结果

这项荟萃分析涵盖9项研究，结果显示，PPU治疗患者的合并死亡率为6.68%（95%CI：4.36，9.00），异质性水平较高（I=57%），并发症发生率为23.21%（95%CI：19.72，26.69），异质性水平中等（I=43%）。值得注意的是，24小时后就诊出现并发症的几率高出4倍（95%CI：1.79-8.95），而收缩压较低（调整后比值比4.81；95%CI：1.75-13.20）与并发症风险增加相关。