The therapeutic effect of continuous blood purification on sepsis in children: A systematic review and meta-analysis

IF 1.9 4区 医学 Q3 INFECTIOUS DISEASES Journal of Infection and Chemotherapy Pub Date : 2024-07-20 DOI:10.1016/j.jiac.2024.07.016
Minghai Zhang , Zhijie Ling , Wei Zhang , Qing Huang
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Abstract

Background

Previous meta-analyses have systematically assessed the therapeutic effect of continuous blood purification (CBP) in adult patients with sepsis. Considering infection etiology and host response of sepsis is different in children, this systematic review and meta-analysis aims to evaluate the clinical efficacy of CBP in children with sepsis.

Methods

Studies were searched from the Pubmed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases. Outcomes included vital signs, coagulation markers, organ function markers, immune markers, inflammatory markers, and prognostic markers. Heterogeneity was evaluated by the I-square statistic (I2), and sensitivity analysis was performed.

Results

24 studies were included in this meta-analysis. Pooled results showed that CBP decreased levels of alanine transaminase (ALT) (weighted mean difference [WMD] = −44.867, 95%CI: 64.809 to −24.926), aspartate aminotransferase (AST) (WMD = −55.373, 95%CI: 73.286 to −37.460), blood urea nitrogen (BUN) (WMD = −2.581, 95%CI: 4.539 to −0.622), and serum creatinine (Scr) (WMD = −11.567, 95%CI: 19.509 to −3.625). The percentage of CD3+ cells (WMD = 8.242, 95%CI: 3.339 to 13.144) and CD4+ cells (WMD = 4.278, 95%CI: 3.252 to 5.303, I2 = 3.1 %) were increased in the CBP group. C-reaction protein (CRP) (WMD = −20.699, 95%CI: 34.740 to −6.657) and tumor necrosis factor-α (TNF-α) (WMD = −19.185, 95%CI: 34.133 to −4.237) were reduced after CBP treatment. Pediatric critical illness score (PCIS) was increased (WMD = 7.916, 95%CI: 4.317 to 11.516) and the risk of 28-day mortality (risk ratio [RR] = 0.781, 95%CI: 0.632 to 0.965) was lower in the CBP group.

Conclusions

CBP reduced the level of inflammatory markers, increased the level of immune markers, and improved organ function and prognosis, which may provide evidence for the use of CBP in sepsis children patients.
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持续血液净化对儿童败血症的治疗效果:系统回顾和荟萃分析。
背景:以往的荟萃分析系统地评估了持续血液净化(CBP)对脓毒症成人患者的治疗效果。考虑到儿童败血症的感染病因和宿主反应不同,本系统综述和荟萃分析旨在评估 CBP 对儿童败血症患者的临床疗效:方法:从 Pubmed、Embase、Cochrane Library、Web of Science、中国国家知识基础设施(CNKI)、万方数据库和 VIP 数据库中检索研究。研究结果包括生命体征、凝血指标、器官功能指标、免疫指标、炎症指标和预后指标。用 I 平方统计量(I2)评估异质性,并进行敏感性分析。汇总结果显示,CBP 可降低丙氨酸转氨酶(ALT)(加权平均差 [WMD] = -44.867,95%CI:-64.809 至 -24.926)、天冬氨酸转氨酶(AST)(WMD = -55.373,95%CI:-73.286 至 -37.460)、血尿素氮(BUN)(WMD = -2.581,95%CI:-4.539 至 -0.622)和血清肌酐(Scr)(WMD = -11.567,95%CI:-19.509 至 -3.625)。CD3+ 细胞(WMD = 8.242,95%CI:3.339 至 13.144)和 CD4+ 细胞(WMD = 4.278,95%CI:3.252 至 5.303,I2 = 3.1%)的百分比在 CBP 组中有所增加。CBP 治疗后,C 反应蛋白(CRP)(WMD = -20.699,95%CI:-34.740 至 -6.657)和肿瘤坏死因子-α(TNF-α)(WMD = -19.185,95%CI:-34.133 至 -4.237)降低。CBP组的小儿危重病评分(PCIS)增加(WMD = 7.916,95%CI:4.317 至 11.516),28天死亡风险(风险比 [RR] = 0.781,95%CI:0.632 至 0.965)降低:CBP降低了炎症标志物的水平,提高了免疫标志物的水平,改善了器官功能和预后,为在败血症儿童患者中使用CBP提供了证据。
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来源期刊
Journal of Infection and Chemotherapy
Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
4.10
自引率
4.50%
发文量
303
审稿时长
47 days
期刊介绍: The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.
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