与急性呼吸困难综合征相关的死亡率,2009-2019:系统性审查和元分析
Divyajot Sadana1, Simrat Kaur2, Kesavan Sankaramangalam3
1Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, (OH), USA.
概括
急性呼吸困难综合征 (ARDS) 的死亡率很高,2009-2019年的研究显示,近40%的患者死亡. 与随机对照试验相比,观察性研究中的死亡率更高.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 流行病学 流行病学
背景情况:
- 急性呼吸困扰综合征 (ARDS) 是重症监护病房中常见且严重的疾病.
- 现有的研究报告了ARDS的高度可变的死亡率.
- 了解ARDS死亡率趋势对于改善患者的治疗结果至关重要.
研究的目的:
- 系统地调查与ARDS相关的死亡率.
- 分析2009年H1N1大流行之前到COVID-19大流行开始 (2009-2019) 期间的ARDS死亡率.
- 为了比较不同研究设计之间的死亡率.
主要方法:
- 在MEDLINE和Embase进行了系统的文献搜索,搜索了2009年1月至2019年12月期间发表的研究.
- 对来自随机对照试验 (RCT) 和观察性研究的死亡率数据进行了比例元分析.
- 对偏差风险的评估是使用Cochrane RoB-2进行RCT和ROBINS-1进行非随机研究.
主要成果:
- 总共有102项研究 (34项RCT,68项观察性),包括24,158名患者,符合纳入标准.
- 从2009年至2019年的所有研究中,ARDS的综合死亡率为39.4%.
- 观察性研究中的死亡率 (41.8%) 与RCT (34.5%) 相比显著更高.
结论:
- ARDS继续与高死亡率有关.
- 在观察性研究和RCT之间,报告死亡率存在显著差异.
- 未来的研究应该根据ARDS表型区分死亡率,并坚持基于证据的医学原则.
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