Gras Emmanuelle, Monzo-Gallo Patricia, Azoyan Loris, Garcia-Vidal Carolina, Lanternier Fanny, Brissot Eolia, Guitard Juliette, Lacombe Karine, Dechartres Agnès, Surgers Laure
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, F75012, France.
Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.
Sci Rep. 2025 Aug 21;15(1):30724. doi: 10.1038/s41598-025-16066-6.
Improving prevention and treatment strategies for invasive fungal infections (IFI) is essential to reduce associated morbidity and mortality. We performed a systematic review and meta-analyses to assess factors associated with IFI in adult patients with hematological malignancies and/or hematopoietic stem cell transplantation (HSCT).
We searched PubMed, Embase, CENTRAL and the grey literature from 01/01/2002 to 08/02/2024.
Eligible studies were case-control or cohort studies including adult patients with hematological malignancies and/or HSCT and reporting risk factors for IFI.
Adult patients with hematological malignancies and/or HSCT. Assessment of risk of bias. Risk of bias assessment was assessed independently using the Critical Appraisal Skills Programme checklists for cohort studies and case-control studies. Methods of data synthesis. Study selection and data extraction were done independently. Adjusted estimates were pooled using random effects models. Among 12 624 references identified, 69 studies (reporting 2917 IFI) were included in the systematic review, 20 of which were included in meta-analyses. Factors independently associated with IFI included previous allo-HSCT (pooled aHR 3.21 [95%CI 1.54-6.71]), especially with a haploidentical donor (pooled aHR 2.41 [95%CI 1.27-4.57]), acute graft vs. host disease (aGvHD) ≥ 2 (pooled aHR 2.59 [95%CI 1.36-4.90]), corticosteroids (pooled aOR 2.84 [95%CI 1.42-5.70]) or T-cell depleting agents (pooled aOR 2.73 [95%CI 1.61-4.64]). Antifungal prophylaxis was a protective factor for IFI (pooled aOR 0.20 [95%CI 0.13-0.28]). The identification of factors independently associated with IFI may help to stratify IFI risk among hematological patients.
PROSPERO, CRD42023429103.
改进侵袭性真菌感染（IFI）的预防和治疗策略对于降低相关的发病率和死亡率至关重要。我们进行了一项系统评价和荟萃分析，以评估血液系统恶性肿瘤和/或造血干细胞移植（HSCT）成年患者中与IFI相关的因素。
我们检索了2002年1月1日至2024年2月8日期间的PubMed、Embase、CENTRAL和灰色文献。
符合条件的研究为病例对照研究或队列研究，纳入血液系统恶性肿瘤和/或HSCT成年患者，并报告IFI的危险因素。
血液系统恶性肿瘤和/或HSCT成年患者。偏倚风险评估。使用队列研究和病例对照研究的关键评估技能计划清单独立评估偏倚风险。数据合成方法。研究选择和数据提取独立进行。使用随机效应模型汇总调整后的估计值。在检索到的12624篇参考文献中，69项研究（报告2917例IFI）纳入系统评价，其中20项纳入荟萃分析。与IFI独立相关的因素包括既往异基因HSCT（汇总aHR 3.21 [95%CI 1.54 - 6.71]），尤其是单倍体相合供者（汇总aHR 2.41 [95%CI 1.27 - 4.57]）、急性移植物抗宿主病（aGvHD）≥2级（汇总aHR 2.59 [95%CI 1.36 - 4.90]）、使用皮质类固醇（汇总aOR 2.84 [95%CI 1.42 - 5.70]）或T细胞清除剂（汇总aOR 2.73 [95%CI 1.61 - 4.64]）。抗真菌预防是IFI的保护因素（汇总aOR 0.20 [95%CI 0.13 - 0.28]）。识别与IFI独立相关的因素可能有助于对血液系统疾病患者的IFI风险进行分层。
PROSPERO，CRD42023429103。
