中枢神经系统感染的神经影像学预后:系统回顾和荟萃分析。

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Augustin Gaudemer, Netanel Covier, Marie-Cécile Henry-Feugeas, Jean-François Timsit, Philippa Catherine Lavallée, Etienne de Montmollin, Augustin Lecler, Antoine Khalil, Romain Sonneville, Camille Couffignal
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引用次数: 0

摘要

背景:中枢神经系统(CNS)感染预后严重,通常需要重症监护病房(ICU)住院。本研究评估了神经影像学对全型中枢神经系统感染患者的预后价值。方法:采用预先确定的策略,首先对PubMed/MEDLINE、PubMed Central、Embase、Cochrane和谷歌Scholar进行系统检索。纳入2000年1月1日至2023年6月1日期间发表的符合条件的研究。我们考虑了随机对照试验、非随机试验、队列研究,但不包括摘要、成本-效果分析、信函、会议记录、系统评价和荟萃分析。两位作者独立筛选出版物并提取数据。meta分析采用随机效应模型。主要结局为:(1)不良结局,定义为严重功能残疾或死亡;(2)死亡率。计算每个神经影像学特征的合并优势比(OR)和95%置信区间(95% ci)。我们根据中枢神经系统感染类型(细菌性脑膜炎、中枢神经系统结核、中枢神经系统隐球菌病、病毒性脑炎和脑脓肿)、国家收入和ICU住院情况进行了预先指定的亚组分析。结果:在7864项研究中,83项符合纳入标准,48项研究(6434例患者)纳入meta分析。MRI异常(OR: 3.55;95%置信区间:1.81—-6.96;I²=0%),脑缺血(OR: 4.65;95%置信区间:3.14—-6.88;I²=28.5%),脑积水(OR: 4.56;95%置信区间:2.49—-8.36;I²=61.5%)与不良结局显著相关。脑积水(OR, 3.99;95%可信区间1.83 - -8.70;I²=61%)和脑缺血(OR, 3.51;95%置信区间,2.22 - -5.54;I²=16.4%)与死亡率相关。这些关联在细菌性脑膜炎患者和中枢神经系统结核患者中保持一致,但在其他中枢神经系统感染中则不一致。根据国家收入和ICU住院状况进行的亚组分析显示了类似的结果。结论:神经影像学为中枢神经系统感染患者提供了重要的预后信息。异常MRI表现、脑缺血和脑积水与不良结果相关,尤其是细菌性脑膜炎和中枢神经系统结核。在讨论受影响患者的预后时应考虑这些神经影像学特征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neuroimaging for prognosis of central nervous system infections: a systematic review and meta-analysis.

Background: Central nervous system (CNS) infections carry a severe prognosis and often require intensive care unit (ICU) admission. This study evaluated the prognostic value of neuroimaging in patients with all-type CNS infections.

Methods: Using a predefined strategy, we first conducted a systematic search of PubMed/MEDLINE, PubMed Central, Embase, Cochrane and Google Scholar. Eligible studies published between January 1st, 2000, and June 1st, 2023, were included. We considered randomized controlled trials, non-randomized trials, cohort studies, excluding abstracts, cost-effectiveness analyses, letters, conference proceedings, systematic reviews, and meta-analyses. Two authors independently screened publications and extracted data. The meta-analysis was performed using a random-effects model. The main outcomes were (1) unfavorable outcome, defined as severe functional disability or death, and (2) mortality. Pooled odds ratios (OR) and 95% confidence intervals (95%CI) were calculated for each neuroimaging feature. We performed prespecified subgroup analyses depending on type of CNS infection (bacterial meningitis, CNS tuberculosis, CNS cryptococcosis, viral encephalitis, and brain abscess), country income, and ICU admission status.

Results: Of 7,864 studies identified, 83 met the inclusion criteria, with 48 studies (6,434 patients) included in the meta-analysis. Abnormal MRI (OR: 3.55; 95%CI: 1.81-6.96; I²=0%), brain ischemia (OR: 4.65; 95%CI: 3.14-6.88; I²=28.5%), and hydrocephalus (OR: 4.56; 95%CI: 2.49-8.36; I²=61.5%) were significantly associated with unfavorable outcome. Hydrocephalus (OR, 3.99; 95%CI 1.83-8.70; I²=61%) and brain ischemia (OR, 3.51; 95%CI, 2.22-5.54; I²=16.4%) were associated with mortality. These associations remained consistent in patients with bacterial meningitis and in patients with CNS tuberculosis, but not in other CNS infections. Subgroup analyses depending on country income and ICU admission status revealed similar findings.

Conclusion: Neuroimaging provides essential prognostic information in patients with CNS infections. Abnormal MRI findings, cerebral ischemia, and hydrocephalus are associated with unfavorable outcome, particularly in bacterial meningitis and CNS tuberculosis. These neuroimaging features should be considered when discussing prognosis in affected patients.

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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