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Lancet Infect Dis:在发热期即可预测登革热后续发展成重症的临床因素

2021-02-26 MedSci原创 MedSci原创

本研究旨在确定与重症登革热疾病发展相关的发热阶段特别容易发现的因素。

准确预测早期登革热进展成重症疾病的的能力对于患者分类和临床管理都至关重要。既往研究发现,重症疾病的部分预测因素存在很大的异质性。

本研究旨在确定与重症登革热疾病发展相关的发热阶段特别容易发现的因素。

研究人员筛查了8个医疗数据库从1997年1月1日至2020年1月30日期间的数据,通过系统回顾和Meta分析来鉴定发热过程中与发展成重症相关的预测因素。

在筛查的6643项研究中,其中150项被纳入本次系统分析,122篇包含25个潜在预测因素的文章被纳入Meta分析。

发展成重症相关因素

在主要分析中,女性患者发展成重症登革热的风险高于男性患者(16.2% vs 10.5%,优势比[OR] 1.13),但中儿童亚组分析中无明显性别差异。与重症登革热相关的基础疾病有糖尿病(31.4% vs 16.0%;粗略OR 4.38)、肾病(45.8% vs 16.0%;4.67)和血管疾病(23.1% vs 8.6%;2.79)。

发展成重症相关因素

发热期间与重症疾病进展相关的临床特征是呕吐(13.5% vs 6.8%;2.25)、腹痛和压痛(17.7% vs 8.1%;1.92)、自发性或粘膜出血(17.9% vs 10.8%;1.57)和有临床积液(42.1% vs 14.9%;4.61)。

进展成重症的患者在疾病初期(前4天)表现为血小板计数低、血清白蛋白低、氨基转移酶浓度升高。2型登革热病毒与儿童重症疾病有关。继发感染也有重症登革热有关(11.8% vs 5.2%;OR 2.26)。

综上,该分析支持对2009年WHO登革热指南中描述的警告信号进行监控。此外,在疾病的发热期进行感染性血清型检测和监测血小板计数以及血清白蛋白、AST和ALT浓度可以改善对重症登革热的早期预测。

原始出处:

Sorawat Sangkaew, et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. The Lancet Infectious Disease. February 25, 2021. https://doi.org/10.1016/S1473-3099(20)30601-0

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    2021-11-02 zhaojie88
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    2021-04-02 howi
  4. [GetPortalCommentsPageByObjectIdResponse(id=2013592, encodeId=e99220135922e, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Nov 02 15:14:28 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831040, encodeId=8913183104003, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Mar 11 08:14:28 CST 2021, time=2021-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2007585, encodeId=931d200e585c5, content=<a href='/topic/show?id=1ec222e50e6' target=_blank style='color:#2F92EE;'>#临床因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22750, encryptionId=1ec222e50e6, topicName=临床因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 02 21:14:28 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034185, encodeId=405b1034185db, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 26 19:14:28 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943763, encodeId=270a943e63bb, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Feb 26 17:01:22 CST 2021, time=2021-02-26, status=1, ipAttribution=)]
    2021-02-26 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2013592, encodeId=e99220135922e, content=<a href='/topic/show?id=7d69598468' target=_blank style='color:#2F92EE;'>#Dis#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5984, encryptionId=7d69598468, topicName=Dis)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Nov 02 15:14:28 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1831040, encodeId=8913183104003, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Thu Mar 11 08:14:28 CST 2021, time=2021-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2007585, encodeId=931d200e585c5, content=<a href='/topic/show?id=1ec222e50e6' target=_blank style='color:#2F92EE;'>#临床因素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22750, encryptionId=1ec222e50e6, topicName=临床因素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Apr 02 21:14:28 CST 2021, time=2021-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034185, encodeId=405b1034185db, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 26 19:14:28 CST 2021, time=2021-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943763, encodeId=270a943e63bb, content=好文章!, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160806/IMG57A5698BDB0244113.jpg, createdBy=32a91358059, createdName=jyzxjiangqin, createdTime=Fri Feb 26 17:01:22 CST 2021, time=2021-02-26, status=1, ipAttribution=)]
    2021-02-26 jyzxjiangqin

    好文章!

    0

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