Wongyikul Pakpoom, Klangbud Wiyada Kwanhian, Chatatikun Moragot, Phinyo Phichayut
Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Department of Biomedical Informatics and Clinical Epidemiology (BioCE), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Epidemiologia (Basel). 2025 Apr 1;6(2):17. doi: 10.3390/epidemiologia6020017.
: This study aimed to evaluate the prognostic impact of coinfections and other clinical factors on mortality in melioidosis patients, providing a comprehensive analysis through systematic review and meta-analysis. A systematic search was conducted in PubMed, Embase, Scopus, and other sources for studies published from their inception to August 2023. Studies reporting mortality outcomes in melioidosis patients with and without coinfections were included. Mixed-effects logistic regression models were used to estimate the causal association of each prognostic factor on the outcome. Directed acyclic graphs (DAGs) were used to guide confounding adjustment, and missing data were handled using multiple imputations. A total of 346 studies involving 509 patients were analyzed. Coinfections were observed in 10.8% of patients with tuberculosis and spp. being the most common. Disseminated disease significantly increased the odds of death (OR 4.93, 95% CI: 2.14-11.37, < 0.001). Coinfections were associated with a higher mortality rate, but the association was not statistically significant (OR 2.70, 95% CI: 0.53-13.90, = 0.172). Sensitivity analyses confirmed the robustness of the findings. Other factors, including diabetes mellitus and agricultural occupation, were evaluated for their associations with mortality. Disseminated melioidosis remains a significant factor influencing prognosis. Although less common, coinfections may contribute to worsen patient outcomes, emphasizing the importance of immediate and accurate diagnosis and comprehensive management.
本研究旨在评估合并感染及其他临床因素对类鼻疽病患者死亡率的预后影响，通过系统评价和荟萃分析提供全面的分析。在PubMed、Embase、Scopus和其他来源中进行了系统检索，以查找从起始到2023年8月发表的研究。纳入报告有或无合并感染的类鼻疽病患者死亡率结果的研究。使用混合效应逻辑回归模型估计每个预后因素与结局之间的因果关联。使用有向无环图（DAG）指导混杂因素调整，并使用多重插补处理缺失数据。共分析了涉及509例患者的346项研究。在10.8%的结核病患者中观察到合并感染，其中 spp.最为常见。播散性疾病显著增加死亡几率（OR 4.93，95%CI：2.14 - 11.37，<0.001）。合并感染与较高的死亡率相关，但该关联无统计学意义（OR 2.70，95%CI：0.53 - 13.90， = 0.172）。敏感性分析证实了研究结果的稳健性。对包括糖尿病和农业职业在内的其他因素与死亡率的关联进行了评估。播散性类鼻疽病仍然是影响预后的重要因素。虽然合并感染较少见，但可能导致患者结局恶化，强调了立即准确诊断和综合管理的重要性。
