Meta-analysis Of Risk Factors For Pulmonary Infection In Patients After Liver Transplantation

Objective: To systematically analyze the risk factors for pulmonary infection in patients after liver transplantation,in order to provides a basis for the formulation of infection control strategies.Methods: Eight databases including the Cochrane Library,Pubmed,Embase,Web of Science,China National Knowledge Infrastructure,Wan Fang Database,Chinese Science and Technology Periodical Database and Chinese Biological Medical Literature Database were searched from inception to March 2019.Two researchers independently screen,extract data and quality evaluation according to the criteria of inclusion and exclusion of literature,and use Rev Man5.3 software for Meta analysis.The quality of evidence of all outcomes was rated by using the Grades of Recommendation Assessment,Development,and Evaluation approach.Results:A total of Twenty-two studies were included,involving 2448 patients after liver transplantation,including 632 cases of pulmonary infection and 1816 cases of non-pulmonary infection.The results of Meta analysis showed that there was no significant difference between groups(P>0.05)in sex [male:OR=1.14,95%CI(0.81,1.60),female:OR=0.88,95%CI(0.62,1.23)],age [MD=0.11,95%CI(-1.24,1.47)],reoperation[OR=1.63,95%CI(0.89,2.99)] and postoperative acute immune rejection [OR=1.81,95%CI(0.10,32.59)].There was significant difference between groups(P < 0.05)in smoking history [OR=3.07,95%CI(1.98,4.78)],diabetes mellitus [OR=2.86,95%CI(1.60,5.13)],MELD score [MD=6.58,95%CI(2.54,10.62)],grade Child-Pugh C [OR=2.21,95%CI(1.41,3.46)],operation time [SMD=0.77,95%CI(0.60,0.94)],intraoperative transfusion volume [SMD=1.66,95%CI(1.25,2.08)],intraoperative infusion volume[SMD=0.75,95%CI(0.49,1.02)],time of anhepatic phase [MD=8.13,95%CI(5.85,10.41)],mechanical ventilation time [SMD=1.72,95%CI(1.23,2.22)],ICU stay time[SMD=2.13,95%CI(0.93,3.34)],postoperative serum creatinine [SMD=0.86,95%CI(0.65,1.07)],postoperative albumin [MD=-5.58,95%CI(-6.78,-4.38)],postoperative total bilirubin [SMD=2.42,95%CI(1.01,3.83)],postoperative prothrombin time [MD=5.21,95%CI(4.29,6.13)],postoperative platelet [SMD=-0.86,95%CI(-1.12,-0.61)],postoperative ALT [SMD=1.33,95%CI(0.90,1.76)],postoperative pleural effusion[OR=8.04,95%CI(2.66,24.26)]and intraperitoneal hemorrhage [OR=5.53,95%CI(2.41,12.66)].Most of the results were robust,and their quality was moderate.Some of the results are of low quality.Conclusion:The moderate evidence indicates that preoperative smoking history,high MELD score,grade Child-Pugh C,long operation time,mechanical ventilation,long ICU stay time,high bilirubin,high ALT level,prolonged prothrombin time,low platelet,hypoproteinemia,and combined pleural effusion were risk factors for LT postoperative pulmonary infection.The lower evidence indicates that diabetes mellitus,intraoperative massive bleeding and infusion,long time of anhepatic phase,postoperative high serum creatinine levels,and abdominal bleeding are risk factors for LT postoperative pulmonary infection.