Meta-analysis of Risk Factors for Mortality in Patients with Acinetobacter Baumannii Bloodstream Infection

Abstract

Background: Patients with Acinetobacter baumannii bloodstream infection (ABBI) have a poor prognosis and high mortality. Early identification of risk factors for death in patients with ABBI, and appropriate prevention and control measures are extremely important to reduce the mortality. Objective: To systematically evaluate the risk factors of ABBI, which provide evidence for reducing the incidence and mortality of patients. Methods: The published articles and reference works on prognosis risk factors in patients with ABBI were retrieved from inception to January 2021 in the following databases: PubMed, Web of Science, Embase, CNKI, Wanfang and VIP. Those studies that met the inclusion criteria were perform quality evaluation and data analysis. Meta-analysis was performed by the statistical software Stata13.0. Results: A total of 24 articles were included, including 1 203 patients in the death group and 1 319 patients in the survival group. Among the 24 included study factors, 15 showed statistically significant differences(P<0.01), including: age (MD=0.19, 95%CI: 0.08~0.30, P<0.01), APACHE II (MD=0.48, 95%CI: 0.06~0.91, P=0.03), ICU admission (OR=1.91, 95%CI: 1.12~3.26, P=0.02), shock (OR=4.28, 95% CI: 1.05~17.49, P=0.04), septic shock (OR=8.36, 95%CI: 3.71~18.82, P<0.01), renal damage (OR=1.57, 95%CI: 1.19~2.07, P<0.01), diabetes (OR=1.31,95%CI: 1.03~1.68, P=0.03), malignant tumor (OR=1.56, 95%CI: 1.02~2.37, P=0.04 ), liver disease (OR=1.93, 95%CI: 1.25~3.00, P<0.01), hormonal used (OR=5.46, 95%CI: 3.12~9.56, P<0.01), immunosuppression (OR=2.73, 95%CI: 1.82~4.1, P<0.01 ), mechanical ventilation (OR=3.17, 95%CI: 2.34~4.29, P<0.01), deep vein catheterization (OR=2.02, 95%CI: 1.56~2.61, P<0.01), indwelling urinary catheter (OR =2.53, 95%CI: 1.66~3.84, P<0.01), indwelling gastric tube (OR=1.79, 95%CI: 1.21~2.65, P<0.01). Conclusion: The severity of the patient's underlying disease, using of hormones and immunosuppressants, and various invasive operations were the main risk factors for high mortality in ABBI patients. It was necessary to focus on older patients, dynamically monitor the APACHE II score, carefully evaluate the effect of hormone and immunosuppressant application, and strictly control the indications of invasive operation or treatment.