Zixuan Ma , Zhenghui He , Zhifan Li , Ru Gong , Jiyuan Hui , Weiji Weng , Xiang Wu , Chun Yang , Jiyao Jiang , Li Xie , Junfeng Feng
{"title":"老年人群中的创伤性脑损伤：对 222 万人的院内死亡率和风险因素的全球系统回顾和荟萃分析。","authors":"Zixuan Ma , Zhenghui He , Zhifan Li , Ru Gong , Jiyuan Hui , Weiji Weng , Xiang Wu , Chun Yang , Jiyao Jiang , Li Xie , Junfeng Feng","doi":"10.1016/j.arr.2024.102376","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population.</p></div><div><h3>Methods</h3><p>We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses.</p></div><div><h3>Findings</h3><p>We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981–2022) and in severe (1986–2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58–1.82, <em>P</em> < 0.001), male gender 1.34 (95 % CI, 1.25–1.42, <em>P</em> < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02–1.45, <em>P</em> = 0.029), GCS moderate (GCS 9–12 compared to GCS 13–15) 4.33 (95 % CI, 3.13–5.99, <em>P</em> < 0.001), GCS severe (GCS 3–8 compared to GCS 13–15) 23.09 (95 % CI, 13.80–38.63, <em>P</em> < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09–4.96, <em>P</em> < 0.001), hypotension after injury 2.88 (95 % CI, 1.06–7.81, <em>P</em> = 0.038), polytrauma 2.31 (95 % CI, 2.03–2.62, <em>P</em> < 0.001), surgical intervention 2.21 (95 % CI, 1.22–4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24–1.86, <em>P</em> = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23–1.84, <em>P</em> < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04–2.76, <em>P</em> = 0.032), Warfarin 2.26 (95 % CI, 2.05–2.51, <em>P</em> < 0.001), DOACs 1.99 (95 % CI, 1.43–2.76, <em>P</em> < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024–1.034, <em>P</em> < 0.001) for every 1-year increase in age on in-hospital mortality.</p></div><div><h3>Conclusions</h3><p>In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population.</p></div><div><h3>Review registration</h3><p>PROSPERO CRD42022323231</p></div>","PeriodicalId":55545,"journal":{"name":"Ageing Research Reviews","volume":null,"pages":null},"PeriodicalIF":12.5000,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Traumatic brain injury in elderly population: A global systematic review and meta-analysis of in-hospital mortality and risk factors among 2.22 million individuals\",\"authors\":\"Zixuan Ma , Zhenghui He , Zhifan Li , Ru Gong , Jiyuan Hui , Weiji Weng , Xiang Wu , Chun Yang , Jiyao Jiang , Li Xie , Junfeng Feng\",\"doi\":\"10.1016/j.arr.2024.102376\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population.</p></div><div><h3>Methods</h3><p>We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses.</p></div><div><h3>Findings</h3><p>We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981–2022) and in severe (1986–2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58–1.82, <em>P</em> < 0.001), male gender 1.34 (95 % CI, 1.25–1.42, <em>P</em> < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02–1.45, <em>P</em> = 0.029), GCS moderate (GCS 9–12 compared to GCS 13–15) 4.33 (95 % CI, 3.13–5.99, <em>P</em> < 0.001), GCS severe (GCS 3–8 compared to GCS 13–15) 23.09 (95 % CI, 13.80–38.63, <em>P</em> < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09–4.96, <em>P</em> < 0.001), hypotension after injury 2.88 (95 % CI, 1.06–7.81, <em>P</em> = 0.038), polytrauma 2.31 (95 % CI, 2.03–2.62, <em>P</em> < 0.001), surgical intervention 2.21 (95 % CI, 1.22–4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24–1.86, <em>P</em> = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23–1.84, <em>P</em> < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04–2.76, <em>P</em> = 0.032), Warfarin 2.26 (95 % CI, 2.05–2.51, <em>P</em> < 0.001), DOACs 1.99 (95 % CI, 1.43–2.76, <em>P</em> < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024–1.034, <em>P</em> < 0.001) for every 1-year increase in age on in-hospital mortality.</p></div><div><h3>Conclusions</h3><p>In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population.</p></div><div><h3>Review registration</h3><p>PROSPERO CRD42022323231</p></div>\",\"PeriodicalId\":55545,\"journal\":{\"name\":\"Ageing Research Reviews\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":12.5000,\"publicationDate\":\"2024-07-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Ageing Research Reviews\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1568163724001946\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CELL BIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ageing Research Reviews","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1568163724001946","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CELL BIOLOGY","Score":null,"Total":0}
Traumatic brain injury in elderly population: A global systematic review and meta-analysis of in-hospital mortality and risk factors among 2.22 million individuals
Background
Traumatic brain injury (TBI) among elderly individuals poses a significant global health concern due to the increasing ageing population.
Methods
We searched PubMed, Cochrane Library, and Embase from database inception to Feb 1, 2024. Studies performed in inpatient settings reporting in-hospital mortality of elderly people (≥60 years) with TBI and/or identifying risk factors predictive of such outcomes, were included. Data were extracted from published reports, in-hospital mortality as our main outcome was synthesized in the form of rates, and risk factors predicting in-hospital mortality was synthesized in the form of odds ratios. Subgroup analyses, meta-regression and dose-response meta-analysis were used in our analyses.
Findings
We included 105 studies covering 2217,964 patients from 30 countries/regions. The overall in-hospital mortality of elderly patients with TBI was 16 % (95 % CI 15 %-17 %) from 70 studies. In-hospital mortality was 5 % (95 % CI, 3 %-7 %), 18 % (95 % CI, 12 %-24 %), 65 % (95 % CI, 59 %-70 %) for mild, moderate and severe subgroups from 10, 7, and 23 studies, respectively. A decrease in in-hospital mortality over years was observed in overall (1981–2022) and in severe (1986–2022) elderly patients with TBI. Older age 1.69 (95 % CI, 1.58–1.82, P < 0.001), male gender 1.34 (95 % CI, 1.25–1.42, P < 0.001), clinical conditions including traffic-related cause of injury 1.22 (95 % CI, 1.02–1.45, P = 0.029), GCS moderate (GCS 9–12 compared to GCS 13–15) 4.33 (95 % CI, 3.13–5.99, P < 0.001), GCS severe (GCS 3–8 compared to GCS 13–15) 23.09 (95 % CI, 13.80–38.63, P < 0.001), abnormal pupillary light reflex 3.22 (95 % CI, 2.09–4.96, P < 0.001), hypotension after injury 2.88 (95 % CI, 1.06–7.81, P = 0.038), polytrauma 2.31 (95 % CI, 2.03–2.62, P < 0.001), surgical intervention 2.21 (95 % CI, 1.22–4.01, P = 0.009), pre-injury health conditions including pre-injury comorbidity 1.52 (95 % CI, 1.24–1.86, P = 0.0020), and pre-injury anti-thrombotic therapy 1.51 (95 % CI, 1.23–1.84, P < 0.001) were related to higher in-hospital mortality in elderly patients with TBI. Subgroup analyses according to multiple types of anti-thrombotic drugs with at least two included studies showed that anticoagulant therapy 1.70 (95 % CI, 1.04–2.76, P = 0.032), Warfarin 2.26 (95 % CI, 2.05–2.51, P < 0.001), DOACs 1.99 (95 % CI, 1.43–2.76, P < 0.001) were related to elevated mortality. Dose-response meta-analysis of age found an odds ratio of 1.029 (95 % CI, 1.024–1.034, P < 0.001) for every 1-year increase in age on in-hospital mortality.
Conclusions
In the field of elderly patients with TBI, the overall in-hospital mortality and its temporal-spatial feature, the subgroup in-hospital mortalities according to injury severity, and dose-response meta-analysis of age were firstly comprehensively summarized. Substantial key risk factors, including the ones previously not elucidated, were identified. Our study is thus of help in underlining the importance of treating elderly TBI, providing useful information for healthcare providers, and initiating future management guidelines. This work underscores the necessity of integrating elderly TBI treatment and management into broader health strategies to address the challenges posed by the aging global population.
期刊介绍：
With the rise in average human life expectancy, the impact of ageing and age-related diseases on our society has become increasingly significant. Ageing research is now a focal point for numerous laboratories, encompassing leaders in genetics, molecular and cellular biology, biochemistry, and behavior. Ageing Research Reviews (ARR) serves as a cornerstone in this field, addressing emerging trends.
ARR aims to fill a substantial gap by providing critical reviews and viewpoints on evolving discoveries concerning the mechanisms of ageing and age-related diseases. The rapid progress in understanding the mechanisms controlling cellular proliferation, differentiation, and survival is unveiling new insights into the regulation of ageing. From telomerase to stem cells, and from energy to oxyradical metabolism, we are witnessing an exciting era in the multidisciplinary field of ageing research.
The journal explores the cellular and molecular foundations of interventions that extend lifespan, such as caloric restriction. It identifies the underpinnings of manipulations that extend lifespan, shedding light on novel approaches for preventing age-related diseases. ARR publishes articles on focused topics selected from the expansive field of ageing research, with a particular emphasis on the cellular and molecular mechanisms of the aging process. This includes age-related diseases like cancer, cardiovascular disease, diabetes, and neurodegenerative disorders. The journal also covers applications of basic ageing research to lifespan extension and disease prevention, offering a comprehensive platform for advancing our understanding of this critical field.
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