Clinical determinants of the severity of Middle East respiratory syndrome (MERS): a systematic review and meta-analysis

被引:89
作者
Matsuyama, Ryota [1 ,2 ]
Nishiura, Hiroshi [1 ,2 ]
Kutsuna, Satoshi
Hayakawa, Kayoko [3 ]
Ohmagari, Norio
机构
[1] Hokkaido Univ, Grad Sch Med, Kita Ku, Kita 15 Jo Nishi 7 Chome, Sapporo, Hokkaido 0608638, Japan
[2] Japan Sci & Technol Agcy, CREST, 4-1-8 Honcho, Kawaguchi, Saitama 3320012, Japan
[3] Natl Ctr Global Hlth & Med Hosp, Dis Control & Prevent Ctr, Shinjuku Ku, 1-21-1 Toyama, Tokyo 1628655, Japan
基金
日本科学技术振兴机构;
关键词
Case fatality ratio; Middle East respiratory syndrome; Comorbidity; Ascertainment bias; SYNDROME CORONAVIRUS INFECTION; REPUBLIC-OF-KOREA; SAUDI-ARABIA; SOUTH-KOREA; OUTBREAK; KINGDOM; RIBAVIRIN; DEATH; RISK; OUTCOMES;
D O I
10.1186/s12889-016-3881-4
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: While the risk of severe complications of Middle East respiratory syndrome (MERS) and its determinants have been explored in previous studies, a systematic analysis of published articles with different designs and populations has yet to be conducted. The present study aimed to systematically review the risk of death associated with MERS as well as risk factors for associated complications. Methods: PubMed and Web of Science databases were searched for clinical and epidemiological studies on confirmed cases of MERS. Eligible articles reported clinical outcomes, especially severe complications or death associated with MERS. Risks of admission to intensive care unit (ICU), mechanical ventilation and death were estimated. Subsequently, potential associations between MERS-associated death and age, sex, underlying medical conditions and study design were explored. Results: A total of 25 eligible articles were identified. The case fatality risk ranged from 14.5 to 100%, with the pooled estimate at 39.1%. The risks of ICU admission and mechanical ventilation ranged from 44.4 to 100% and from 25.0 to 100%, with pooled estimates at 78.2 and 73.0%, respectively. These risks showed a substantial heterogeneity among the identified studies, and appeared to be the highest in case studies focusing on ICU cases. We identified older age, male sex and underlying medical conditions, including diabetes mellitus, renal disease, respiratory disease, heart disease and hypertension, as clinical predictors of death associated with MERS. In ICU case studies, the expected odds ratios (OR) of death among patients with underlying heart disease or renal disease to patients without such comorbidities were 0.6 (95% Confidence Interval (CI): 0.1, 4.3) and 0.6 (95% CI: 0.0, 2.1), respectively, while the ORs were 3.8 (95% CI: 3.4, 4.2) and 2.4 (95% CI: 2.0, 2.9), respectively, in studies with other types of designs. Conclusions: The heterogeneity for the risk of death and severe manifestations was substantially high among the studies, and varying study designs was one of the underlying reasons for this heterogeneity. A statistical estimation of the risk of MERS death and identification of risk factors must be conducted, particularly considering the study design and potential biases associated with case detection and diagnosis.
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页数:10
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