{"title":"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。","authors":"Minghai Zhang , Zhijie Ling , Wei Zhang , Qing Huang","doi":"10.1016/j.jiac.2024.07.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (I<sup>2</sup>), and sensitivity analysis was performed.</div></div><div><h3>Results</h3><div>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<sup>+</sup> cells (WMD = 8.242, 95%CI: 3.339 to 13.144) and CD4<sup>+</sup> cells (WMD = 4.278, 95%CI: 3.252 to 5.303, I<sup>2</sup> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The therapeutic effect of continuous blood purification on sepsis in children: A systematic review and meta-analysis\",\"authors\":\"Minghai Zhang , Zhijie Ling , Wei Zhang , Qing Huang\",\"doi\":\"10.1016/j.jiac.2024.07.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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 (I<sup>2</sup>), and sensitivity analysis was performed.</div></div><div><h3>Results</h3><div>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<sup>+</sup> cells (WMD = 8.242, 95%CI: 3.339 to 13.144) and CD4<sup>+</sup> cells (WMD = 4.278, 95%CI: 3.252 to 5.303, I<sup>2</sup> = 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":16103,\"journal\":{\"name\":\"Journal of Infection and Chemotherapy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-07-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Infection and Chemotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1341321X24001946\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X24001946","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
The therapeutic effect of continuous blood purification on sepsis in children: A systematic review and meta-analysis
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.
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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