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| Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis |
| YANG Luo-xian，CHENG Qing-lin，ZHANG Qiong，XIE Li
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| Hangzhou Center for Disease Control and Prevention，Hangzhou，Zhejiang 310021，China |
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Abstract Objective The objective of our study was to conduct meta-analyses that examined the association between H7N9-infected case-fatality risk（CFR）and underlying medical conditions（UMCs）by adjusting some potential factors variables. Methods The articles of observational studies and randomized controlled clinical trials（RCT）on the association between UMCs and the CFR of H7N9-infected patients were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate odds ratio（OR）or adjusted OR（AOR）and 95% confidence interval（CI）to assess the association between H7N9-infected CFR and UMCs. Results Among 1 934 screened articles，we identified 14 articles reporting the CFR of H7N9-infected patients based on UMCs data. The pooled summary estimates from these studies indicated that UMCs significantly increased the risk of death in H7N9 patients （OR=2.20，95%CI：1.76-2.76）. Subgroup analyses showed chronic respiratory diseases （CRD，OR=4.43，95%CI：1.73-11.31），immuno-suppressive disorders（ISD，OR=4.65，95% CI：1.48-44.70），and two UMCs and above（OR=2.13，95% CI：1.26-5.97） were significantly associated with H7N9-infected CFR； while 60 years old and above （AOR=4.83，95%CI：1.29-18.09），male（AOR=2.35，95%CI：1.03-5.39），time intervals to oseltamivir treatment（over 5 days）（AOR=5.74，95%CI：1.15-28.66）and hospitalization（over 8 days）（AOR=2.72，95%CI：1.20-6.15），and initially bilateral lungs infection（AOR=7.95，95%CI：1.56-40.41）of UMCs patients who died from H7N9 infection are much greater compared with non-UMCs. Stratification analyses confirmed statistically significant increasing effects of CFR were observed in 60 years old and above（AOR=2.20，95%CI：1.12-4.30），time intervals to oseltamivir treatment（over 5 days）（AOR=3.19，95%CI：1.56-6.53），and initially bilateral lungs infection（AOR=3.48， 95%CI：1.74-6.95）compared with 0-59 years old，time intervals to oseltamivir treatment（5 days and below），and initially single lung infection respectively in H7N9-infected patients with UMCs. Conclusions We find that only CRD，ISD，and two UMCs and above are associated with increased risk of death in H7N9-infected patients. We also suggest that a high CFR is associated with 60 years old and above，delayed antiviral treatment，and initially bilateral lungs infection in H7N9-infected patients with UMCs.
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Published: 04 June 2018
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