第一波和随后的SARS-CoV-2波的结果比较——系统回顾和荟萃分析

IF 2 Q3 RESPIRATORY SYSTEM Multidisciplinary Respiratory Medicine Pub Date : 2023-11-02 DOI:10.4081/mrm.2023.933
Tulio Caldonazo, Ricardo E. Treml, Felipe S.L. Vianna, Panagiotis Tasoudis, Hristo Kirov, Murat Mukharyamov, Torsten Doenst, João M. Silva Jr
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引用次数: 0

摘要

背景:在SARS-CoV-2大流行初期,由于具体治疗方法尚不清楚,卫生保健专业人员处理COVID-19时只能依靠一般的支持措施。随后的浪潮可能面临新的诊断和治疗工具(例如抗病毒药物和疫苗)。我们进行了荟萃分析和系统回顾,比较了第一波和随后两波的临床终点。方法:对三个数据库进行评估。主要终点是住院死亡率。次要结局为重症监护病房(ICU)死亡率、ICU住院时间(LOS)、急性肾功能衰竭、体外膜氧合(ECMO)植入、机械通气时间、医院LOS、全身血栓栓塞、心肌炎和呼吸机相关性肺炎。结果:共纳入25项研究,126153例患者。主要终点无显著差异(OR=0.94, 95% CI 0.83-1.07, p=0.35)。第一波组ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p= 0.01)、急性肾功能衰竭(OR=1.71, 95% CI 1.36-2.15, p= 0.01)和ECMO植入(OR=1.64, 95% CI 1.06-2.52, p=0.03)发生率较高。其他终点无显著性差异。结论:分析提示,与后续波组相比,第一波组ICU LOS、急性肾功能衰竭和ECMO植入的发生率更高,在院内或ICU死亡率、机械通气时间、院内LOS、全身性血栓栓塞、心肌炎或呼吸机相关性肺炎方面无显著差异。
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Outcomes comparison between the first and the subsequent SARS-CoV-2 waves – a systematic review and meta-analysis
Background: In the beginning of the SARS-CoV-2 pandemic, health care professionals dealing with COVID-19 had to rely exclusively on general supportive measures since specific treatments were unknown. The subsequent waves could be faced with new diagnostic and therapeutic tools (e.g., anti-viral medications and vaccines). We performed a meta-analysis and systematic review to compare clinical endpoints between the first and subsequent waves. Methods: Three databases were assessed. The primary outcome was in-hospital mortality. The secondary outcomes were intensive care unit (ICU) mortality, ICU length of stay (LOS), acute renal failure, extracorporeal membrane oxygenation (ECMO) implantation, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis and ventilator associated pneumonia. Results: A total of 25 studies with 126,153 patients were included. There was no significant difference for the primary endpoint (OR=0.94, 95% CI 0.83-1.07, p=0.35). The first wave group presented higher rates of ICU LOS (SMD= 0.23, 95% CI 0.11-0.35, p<0.01), acute renal failure (OR=1.71, 95% CI 1.36-2.15, p<0.01) and ECMO implantation (OR=1.64, 95% CI 1.06-2.52, p=0.03). The other endpoints did not show significant differences.Conclusions: The analysis suggests that the first wave group, when compared with the subsequent waves group, presented higher rates of ICU LOS, acute renal failure and ECMO implantation, without significant difference in in-hospital or ICU mortality, mechanical ventilation time, hospital LOS, systemic thromboembolism, myocarditis or ventilator-associated pneumonia.
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来源期刊
CiteScore
4.40
自引率
0.00%
发文量
23
审稿时长
>12 weeks
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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