合并病毒感染增加急性胰腺炎的死亡率并恶化预后：一项系统回顾和荟萃分析。

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-02-01 DOI:10.1016/j.pan.2024.12.005

Gefu Cai , Eszter Ágnes Szalai , Petrana Martinekova , Ximeng Li , Xinyi Qian , Dániel Sándor Veres , Zoltán Péterfi , Jaishree Biswakarma , Rita Nagy , Alexandra Mikó , Szabolcs Ábrahám , Bálint Erőss , Péter Hegyi , Andrea Szentesi

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引用次数: 0

摘要

背景：急性胰腺炎（AP）是一种主要的健康威胁，严重形式的死亡率很高。虽然酒精和胆汁诱导因素是最常见的原因，但越来越多的证据表明，病毒感染，如严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）和人类免疫缺陷病毒（HIV）也可能引发AP的发展。我们的研究旨在更详细地探讨这种联系。方法：在PROSPERO注册后，于2023年2月系统检索PubMed、Embase、Cochrane图书馆、中国科技期刊库、中国国家知识基础设施、万方数据知识服务平台。我们纳入了以下PECO框架的研究：人群：AP患者，暴露/比较：有/没有病毒感染，结局：死亡率、严重程度和AP并发症。合并优势比（OR）以95%置信区间（CIs）计算。结果：总共有29个队列，2295172例患者被确定为荟萃分析，858例用于定性综合。合并SARS-CoV-2感染和AP的患者住院死亡率（OR: 3.15, CI: 2.08-4.76）和坏死（OR: 1.83, CI: 1.13-2.97）的几率更高。与中度和重度AP相比，轻度AP在SARS-CoV-2组的患病率较低（OR: 0.37, CI: 0.14-0.97）。相反，没有证据表明合并HIV感染会增加住院死亡率（OR: 1.12, CI: 0.92-1.37）或脓毒症的发生（OR:1.21, CI: 0.41-3.59）。结论：合并诊断为AP和SARS-CoV-2感染的患者由于死亡率和并发症的风险增加，需要高度关注。没有证据表明艾滋病毒感染会增加更严重后果的风险。

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Concomitant virus infection increases mortality and worsens outcome of acute pancreatitis: A systematic review and meta-analysis

Background

Acute pancreatitis (AP) is a major health threat, with a high mortality rate in severe forms. Though alcohol and bile-induced factors are the most common causes, increasing evidence suggests that viral infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human immunodeficiency virus (HIV) may also trigger AP development. Our study aims to explore this association in greater detail.

Methods

After the PROSPERO registration, we systematically searched PubMed, Embase, Cochrane Library, China Science and Technology Journal Database, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform in February 2023. We included studies with the following PECO framework: Population: AP patients, Exposure/Comparison: with/without virus infection, Outcome: mortality, severity, and complications of AP. Pooled odds ratios (OR) were calculated with 95 % confidence intervals (CIs).

Results

Altogether, 29 cohorts with 2,295,172 patients were identified for the meta-analysis and 858 cases for the qualitative synthesis. Patients with concurrent SARS-CoV-2 infection and AP exhibited heightened odds of in-hospital mortality (OR: 3.15, CI: 2.08–4.76), and necrosis (OR: 1.83, CI: 1.13–2.97). Mild AP was less prevalent in the SARS-CoV-2 group (OR: 0.37, CI: 0.14–0.97) compared to moderately severe and severe AP together. Contrarily, no evidence was found that concomitant HIV infection elevated in-hospital mortality (OR: 1.12, CI: 0.92–1.37) or sepsis occurrence (OR:1.21, CI: 0.41–3.59).

Conclusion

Patients co-diagnosed with AP and SARS-CoV-2 infection require heightened attention due to an increased risk of mortality and complications. No evidence was found that HIV infection elevated the risk of a more severe outcome.

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.