新型冠状病毒感染患者院内死亡危险因素的Meta分析  

Risk Factors of In-hospital Death in COVID-19 Patients:a Meta-analysis

作　　者：张炜宗 袁红 孙金栋 於华敏 史明娟 胡海强 何海英 叶利 章慧慧 白幸华 沈超峰 屠思佳 汪洋 王刚 赵晓峰 余涛 李彩荣 张志 周栋徕 蔡梦阳 宁乐 ZHANG Weizong;YUAN Hong;SUN Jindong;YU Huamin;SHI Mingjuan;HU Haiqiang;HE Haiying;YE Li;ZHANG Huihui;BAI Xinghua;SHEN Chaofeng;TU Sijia;WANG Yang;WANG Gang;ZHAO Xiaofeng;YU Tao;LI Cairong;ZHANG Zhi;ZHOU Donglai;CAI Mengyang;NING Le(Cardiovascular Department,First People's Hospital of Linping District,Hangzhou 311100,China)

机构地区：[1]浙江省杭州市临平区第一人民医院心内科,311100

出　　处：《中国全科医学》2023年第5期607-620,共14页Chinese General Practice

摘　　要：背景新型冠状病毒感染(COVID-19)在全世界大规模流行,已经演变成一场全球的灾难性公共卫生危机;目前关于COVID-19患者院内死亡危险因素的结论尚不统一。目的通过Meta分析探讨COVID-19患者院内死亡的相关危险因素。方法计算机检索Cochrane Library、ScienceDirect、PubMed、Medline、万方数据知识服务平台、中国知网、维普期刊资源整合服务平台,搜索已发表的关于COVID-19患者院内死亡的病例对照研究,检索时限为建库至2021-10-01。筛选文献、提取资料并评价文献质量,采用Stata 15.1软件进行Meta分析,采用Meta回归探索可能的异质性来源。结果最终纳入80篇文献,共405157例患者,其中存活组349923例(86.37%),死亡组55234例(13.63%)。根据纽卡斯尔-渥太华量表(NOS)评分,均为高质量文献。Meta分析结果显示,男性(OR=1.49,95%CI(1.41,1.57),P<0.001)、年龄大(WMD=10.44,95%CI(9.79,11.09),P<0.001)、呼吸困难(OR=2.09,95%CI(1.80,2.43),P<0.001)、疲劳(OR=1.49,95%CI(1.31,1.69),P<0.001)、肥胖(OR=1.46,95%CI(1.43,1.50),P<0.001)、吸烟(OR=1.18,95%CI(1.14,1.23),P<0.001)、脑卒中(OR=2.26,95%CI(1.41,3.62),P<0.001)、肾脏疾病(OR=3.62,95%CI(3.26,4.03),P<0.001)、心血管疾病(OR=2.34,95%CI(2.21,2.47),P<0.001)、高血压(OR=2.23,95%CI(2.10,2.37),P<0.001)、糖尿病(OR=1.84,95%CI(1.74,1.94),P<0.001)、肿瘤(OR=1.86,95%CI(1.69,2.05),P<0.001)、肺部疾病(OR=2.38,95%CI(2.19,2.58),P<0.001)、肝脏疾病(OR=1.65,95%CI(1.36,2.01),P<0.001)、白细胞计数升高(WMD=2.03,95%CI(1.74,2.32),P<0.001)、中性粒细胞计数升高(WMD=1.77,95%CI(1.49,2.05),P<0.001)、总胆红素升高(WMD=3.19,95%CI(1.96,4.42),P<0.001)、天冬氨酸氨基转移酶升高(WMD=13.02,95%CI(11.70,14.34),P<0.001)、丙氨酸氨基转移酶升高(WMD=2.76,95%CI(1.68,3.85),P<0.001)、乳酸脱氢酶升高(WMD=166.91,95%CI(150.17,183.64),P<0.001)、尿素氮升高(WMD=3.11,95%CI(2.61,3.60),P<0.001)、肌酐升高(WMD=22.06,95%CI(19.41,24.72),P<0.001)、C反应蛋白升�Background The worldwide COVID-19 pandemic has turned into a global catastrophic public health crisis,and the conclusion about the risk factors of hospital death in COVID-19 patients is not uniform.Objective To explore risk factors of in-hospital death in patients with COVID-19 by a meta-analysis.Methods Case-control studies about risk factors of in-hospital death in COVID-19 patients were searched from databases of the Cochrane Library,ScienceDirect,PubMed,Medline,Wanfang Data,CNKI and CQVIP from inception to October 1,2021.Literature screening,data extraction and methodological quality assessment were conducted.Meta-analysis was performed using Stata 15.1.Meta-regression was used to explore the potential sources of heterogeneity.Results Eighty studies were included which involving 405157 cases(349923 were survivors(86.37%),and 55234 deaths(13.63%)),that were rated as being of high quality by the Newcastle-Ottawa Scale.Meta-analysis showed that being male(OR=1.49,95%CI(1.41,1.57),P<0.001),older age(WMD=10.44,95%CI(9.79,11.09),P<0.001),dyspnoea(OR=2.09,95%CI(1.80,2.43),P<0.001),fatigue(OR=1.49,95%CI(1.31,1.69),P<0.001),obesity(OR=1.46,95%CI(1.43,1.50),P<0.001),smoking(OR=1.18,95%CI(1.14,1.23),P<0.001),stroke(OR=2.26,95%CI(1.41,3.62),P<0.001),kidney disease(OR=3.62,95%CI(3.26,4.03),P<0.001),cardiovascular disease(OR=2.34,95%CI(2.21,2.47),P<0.001),hypertension(OR=2.23,95%CI(2.10,2.37),P<0.001),diabetes(OR=1.84,95%CI(1.74,1.94),P<0.001),cancer(OR=1.86,95%CI(1.69,2.05),P<0.001),pulmonary disease(OR=2.38,95%CI(2.19,2.58),P<0.001),liver disease(OR=1.65,95%CI(1.36,2.01),P<0.001),elevated levels of white blood cell count(WMD=2.03,95%CI(1.74,2.32),P<0.001),neutrophil count(WMD=1.77,95%CI(1.49,2.05),P<0.001),total bilirubin(WMD=3.19,95%CI(1.96,4.42),P<0.001),aspartate transaminase(WMD=13.02,95%CI(11.70,14.34),P<0.001),alanine transaminase(WMD=2.76,95%CI(1.68,3.85),P<0.001),lactate dehydrogenase(WMD=166.91,95%CI(150.17,183.64),P<0.001),blood urea nitrogen(WMD=3.11,95%CI(2.61,3.60),P<0.001),serum creatinine(WMD=22.06,95%CI(1

关 键 词：新型冠状病毒感染 院内死亡率 危险因素 病例对照研究 META分析 影响因素分析 

分 类 号：R563.12[医药卫生—呼吸系统]