【罂粟摘要】择期手术前淋巴细胞减少与死亡率和发病率的关系：系统回顾和Meta分析

择期手术前淋巴细胞减少与死亡率和发病率的关系：系统回顾和Meta分析

贵州医科大学　高鸿教授课题组

翻译：牛振瑛　修改/编辑：佟睿　审校：曹莹

背景

在一般成年人中，淋巴细胞减少与住院感染风险增加和感染相关死亡有关。不同手术方式的围手术期淋巴细胞减少与死亡率/发病率之间的相关性的证据质量和强度尚未通过系统回顾或Meta分析进行检验。

方法

检索MEDLINE，Embase，Web of Science，Google Scholar和Cochrane数据库，收集从建库到2020年6月29日研究成人淋巴细胞计数和住院死亡率相关性的观察研究。术前淋巴细胞减少定义为淋巴细胞计数1.0-1.5×10⁹L^-1。使用固定或随机效应模型进行Meta分析。使用纽卡斯利-渥太华量表进行质量评估。用I²指数对异质性进行检验。主要观察指标是住院死亡率和30天内的死亡率。

结果

8项研究符合Meta分析的纳入标准，包括4811名患者(年龄范围，46-91岁；女性，20-79%)。这些研究只检查了术前淋巴细胞计数。总体来说，研究的质量为中到高等，纽卡斯利-渥太华标准等级>7。术前淋巴细胞减少与死亡率增加3倍(风险比(RR)=3.22；95%可信区间(CI)，2.19-4.72；P<0.01，I²=0%)和更频繁的主要术后并发症(RR=1.33；95%CI，1.21-1.45；P<0.01，I²=25%)有关，包括心血管并发症(RR=1.77；95%CI，1.45-2.15；P<0.01，I²=0%)、感染(RR=1.45；95%CI，1.19-1.76；P<0.01，I²=0%)和急性肾功能不全(RR=2.66；95%CI，1.49-4.77；P<0.01，I²=1%)。

结论

术前淋巴细胞减少与死亡和并发症的发生率更高有关，与手术类型无关。

原始文献来源

Schroth J, Weber V, Jones TF,et,al.Preoperative lymphopaenia, mortality, and morbidity after elective surgery: systematic review and meta-analysisBr J Anaesth. 2021 Jul;127(1):32-40.  doi: 10.1016/j.bja.2021.02.023.

英文摘要 Abstract

Preoperative lymphopaenia, mortality, and morbidity after elective surgery: systematic review and meta-analysis

Background: In the general adult population, lymphopaenia is associated with an increased risk for hospitalisation with infection and infection-related death. The quality of evidence and strength of association between perioperative lymphopaenia across different surgical procedures and mortality/morbidity has not been examined by systematic review or meta-analysis.

Methods: We searched MEDLINE, Embase, Web of Science, Google Scholar, and Cochrane databases from their inception to June 29, 2020 for observational studies reporting lymphocyte count and in-hospital mortality rate in adults. We defined preoperative lymphopaenia as a lymphocyte count 1.0-1.5×10⁹L^-1. Meta-analysis was performed using either fixed or random effects models. Quality was assessed using the NewcastleeOttawa Scale. The I² index was used to quantify heterogeneity. The primary outcome was in-hospital mortality rate and mortality rate at 30 days.

Results: Eight studies met the inclusion criteria for meta-analysis, comprising 4811 patients (age range, 46-91 yr; female,20-79%). These studies examined preoperative lymphocyte count exclusively. Studies were of moderate to high quality overall, ranking >7 using the Newcastlee Ottawa Scale. Preoperative lymphopaenia was associated with a threefold increase in mortality rate (risk ratio [RR]=3.22; 95% confidence interval [CI], 2.19-4.72; P<0.01, I²=0%) and more frequent major postoperative complications (RR1.33; 95% CI, 1.21-1.45; P<0.01, I²=6%), including cardiovascular morbidity (RR=1.77; 95% CI, 1.45-2.15; P<0.01, I²=0%), infections (RR=1.45; 95% CI, 1.19-1.76; P<0.01, I²=0%), and acute renal dysfunction (RR=2.66; 95% CI, 1.49-4.77; P<0.01, I²=1%).

Conclusion: Preoperative lymphopaenia is associated with death and complications more frequently, independent of the type of surgery.

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