背景:严重感染严重急性呼吸道综合征冠状病毒2(SARS-CoV-2)或流感病毒可导致患者入院重症监护病房(ICU)。有必要了解这两类危重患者的临床特征和预后差异。
方法:我们搜索了Embase,PubMed,和WebofScience的文章,并使用Stata14.0和随机效应模型进行了荟萃分析。本文严格按照系统审查和荟萃分析(PRISMA)指南的首选报告项目编写。
结果:我们的荟萃分析纳入了35篇文章,涉及131,692例2019年ICU冠状病毒病患者(COVID-19)和30,286例ICU流感患者。与流感患者相比,COVID-19患者更可能是男性(比值比(OR)=1.75,95%CI:1.54-1.99)和年龄较大(标准化平均差(SMD)=0.16,95%CI:0.03-0.29)。就实验室测试结果而言,COVID-19患者的淋巴细胞(SMD=0.38,95%CI:0.17-0.59)和血小板计数(SMD=0.52,95%CI:0.29-0.75)较高,但肌酐(SMD=-0.29,95%CI:-0.55-0.03)和降钙素原水平(SMD=-0.78,95%CI:-1.11-0.46)较低。糖尿病(SMD=1.27,95%CI:1.08-1.48)和高血压(SMD=1.30,95%CI:1.05-1.60)在COVID-19患者中更为普遍,而流感患者更容易患癌症(OR=0.52,95%CI:0.44-0.62),肝硬化(OR=0.52,95%CI:0.44-0.62),免疫抑制(OR=0.38,95%CI:0.25-0.58),和慢性肺部疾病(OR=0.35,95%CI:0.24-0.52)。我们还发现COVID-19患者的ICU住院时间更长(SMD=0.20,95%CI:0.05-0.34),更容易发生急性呼吸窘迫综合征(OR=4.90,95%CI:2.77-8.64),死亡率较高(OR=1.35,95%CI:1.17~1.55)。
结论:基本特征存在一些差异,合并症,ICUCOVID-19患者和ICU流感患者的实验室检查结果和并发症。患有COVID-19的危重患者通常需要更多的医疗资源,临床结果更差。PROSPERO注册号:CRD42023452238。
BACKGROUND: Severe infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or influenza virus can cause patients to be admitted to intensive care units (ICUs). It is necessary to understand the differences in clinical characteristics and outcomes between these two types of critically ill patients.
METHODS: We searched Embase, PubMed, and Web of Science for articles and performed a meta-analysis using Stata 14.0 with a random-effects model. This paper was written in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS: Thirty-five articles involving 131,692 ICU patients with coronavirus disease 2019 (COVID-19) and 30,286 ICU patients with influenza were included in our meta-analysis. Compared with influenza patients, COVID-19 patients were more likely to be male (odds ratio (OR) = 1.75, 95% CI: 1.54-1.99) and older (standardized mean difference (SMD) = 0.16, 95% CI: 0.03-0.29). In terms of laboratory test results, COVID-19 patients had higher lymphocyte (SMD = 0.38, 95% CI: 0.17-0.59) and platelet counts (SMD = 0.52, 95% CI: 0.29-0.75) but lower creatinine (SMD = -0.29, 95% CI: -0.55-0.03) and procalcitonin levels (SMD = -0.78, 95% CI: -1.11-0.46). Diabetes (SMD = 1.27, 95% CI: 1.08-1.48) and hypertension (SMD = 1.30, 95% CI: 1.05-1.60) were more prevalent in COVID-19 patients, while influenza patients were more likely to have cancer (OR = 0.52, 95% CI: 0.44-0.62), cirrhosis (OR = 0.52, 95% CI: 0.44-0.62), immunodepression (OR = 0.38, 95% CI: 0.25-0.58), and chronic pulmonary diseases (OR = 0.35, 95% CI: 0.24-0.52). We also found that patients with COVID-19 had longer ICU stays (SMD = 0.20, 95% CI: 0.05-0.34), were more likely to develop acute respiratory distress syndrome (OR = 4.90, 95% CI: 2.77-8.64), and had higher mortality (OR = 1.35, 95% CI: 1.17-1.55).
CONCLUSIONS: There are some differences in the basic characteristics, comorbidities, laboratory test results and complications between ICU patients with COVID-19 and ICU patients with influenza. Critically ill patients with COVID-19 often require more medical resources and have worse clinical outcomes. PROSPERO Registration Number: CRD42023452238.