Risk factors for postoperative pulmonary infection in lung cancer patients: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Xiupeng ¹ ,  GUO Shiping ²

1. Department of Thoracic Surgery, Shanxi Provincial People's Hospital, Taiyuan, 030012, P. R. China;
2. The Second Department of Thoracic Surgery, Shanxi Cancer Hospital, Taiyuan, 030013, P. R. China;

Corresponding author：

GUO Shiping, Email: xwek1147@163.com

Keywords：

Lung cancer; pulmonary infection; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202203079

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically evaluate the risk factors for postoperative pulmonary infection in patients with lung cancer (PPILC), and to provide a theoretical reference for clinicians to prevent the occurrence of PPILC. Methods The databases of CNKI, Wanfang data, VIP, CBM, PubMed, EMbase and The Cochrane Library were searched by computer to collect researches on the risk factors for PPILC. The search period was from 2012 to 2021. Two clinicians independently screened literature and extracted data and assessed studies for risk of bias, cross-checked and agreed. Meta-analysis was performed using RevMan 5.3 software. Results A total of 25 studies were included, including 20 case-control studies, 1 cohort study, and 4 cross-sectional studies, covering 15 129 patients. Twenty case-control studies and 1 cohort study had Newcastle-Ottawa Scale (NOS) scores≥6 points, and 4 cross-sectional studies had the Agency for Health Care Quality and Research (AHRQ) scale scores≥6 points. The results of meta-analysis showed that the risk factors for PPILC included: (1) 4 patient's own factors: age≥60 years, male, smoking history, smoking index≥400; (2) 7 preoperative factors: suffering from diabetes, chronic heart failure and chronic obstructive pulmonary disease, the ratio of forced expiratory volume in 1 second to forced expiratory volume<70%, the ratio of forced expiratory volume in 1 second to the predicted value, preoperative airway colonization, non-standard use of prophylactic antibiotics before surgery; (3) 3 intraoperative factors: operation time≥3 h, thoracotomy, the number of resected lobe≥2; (4) 3 postoperative factors: postoperative pain, postoperative mechanical ventilation≥12 h, postoperative invasive operation. Large number of preoperative lymphocyte, intraoperative systematic lymph node dissection, TNM stage Ⅰ and Ⅱ, and enhanced recovery after surgery were protective factors for PPILC. Conclusion The current research evidence shows that multiple factors are associated with the risk of PPILC. However, considering the influence of the quality and quantity of the included literature, the results of this study urgently need to be further verified by more high-quality clinical studies.

Citation： XIAO Xiupeng, GUO Shiping. Risk factors for postoperative pulmonary infection in lung cancer patients: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(1): 135-144. doi: 10.7507/1007-4848.202203079 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	International agency for research on cancer world cancer report: Cancer research for cancer prevention. https://publications.iarc.fr/586. Accessed on 2022-02-10.
3.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
4.	曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
5.	Simonsen DF, Søgaard M, Bozi I, et al. Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival. Respir Med, 2015, 109(10): 1340-1346.
6.	Dupont G, Flory L, Morel J, et al. Postoperative lymphopenia: An independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study. PLoS One, 2018, 13(10): e0205237.
7.	Liu GW, Sui XZ, Wang SD, et al. Identifying patients at higher risk of pneumonia after lung resection. J Thorac Dis, 2017, 9(5): 1289-1294.
8.	Sarıçam M. Efficacy of preoperative white blood cell count and lymphocyte/monocyte ratio in predicting post-lobectomy pneumonia. Turk Gogus Kalp Damar Cerrahisi Derg, 2021, 29(1): 84-91.
9.	Díaz-Ravetllat V, Ferrer M, Gimferrer-Garolera JM, et al. Risk factors of postoperative nosocomial pneumonia after resection of bronchogenic carcinoma. Respir Med, 2012, 106(10): 1463-1471.
10.	Zhang X, Jin R, Zheng Y, et al. Interactions between the enhanced recovery after surgery pathway and risk factors for lung infections after pulmonary malignancy operation. Transl Lung Cancer Res, 2020, 9(5): 1831-1842.
11.	常涛, 张铸. 肺癌患者术后院内肺部感染的相关因素分析. 中国胸心血管外科临床杂志, 2013, 20(2): 176-180.
12.	李燕江. 胰腺癌根治术预后相关因素分析. 昆明医科大学, 2021.
13.	杜海侠, 赵冬峰, 黄国胜, 等. 非小细胞肺癌患者手术后并发肺炎的相关因素分析. 河南外科学杂志, 2021, 27(6): 66-68.
14.	葛宏飞, 林玲, 翁贤福, 等. 肺癌术后并发肺部感染病原学及危险因素分析. 浙江中西医结合杂志, 2016, 26(5): 498-500.
15.	耿秀丽, 李艳梅, 王樱洁. 肺癌患者术后合并肺部感染的临床特点及影响因素. 中国肿瘤临床与康复, 2019, 26(9): 1054-1057.
16.	韩颖, 彭威军, 魏诗晴, 等. 老年非小细胞肺癌患者术后肺炎危险因素. 中国感染控制杂志, 2019, 18(12): 1132-1136.
17.	林善安, 王晓军, 徐晓文, 等. 肺癌根治术患者围术期肺部感染的危险因素分析及预防措施. 西藏医药, 2020, 41(5): 46-47.
18.	刘东东, 沈剑, 黄思远, 等. 肺癌根治术后肺部感染的相关因素分析. 中华全科医学, 2021, 19(4): 550-553.
19.	彭彬, 李国锋, 许明明. 高龄肺癌根治术患者围术期肺部感染的高危因素分析及预防. 中国肿瘤临床与康复, 2018, 25(12): 1435-1438.
20.	彭武君, 张文林, 刘君德, 等. 气道定植菌对肺癌患者术后肺部感染的影响因素分析. 中华医院感染学杂志, 2019, 29(4): 508-511.
21.	万青梅. 老年肺癌患者术后并发肺部感染的危险因素分析及防治对策. 西南军医, 2014, 16(4): 398-399.
22.	王庆华, 蔡宏剑, 袁荣正, 等. 肺癌患者术后并发肺部感染的危险因素分析. 中国癌症防治杂志, 2020, 12(1): 95-99.
23.	王震. 肺癌患者术后肺部感染的现状、病原菌分布特点及其危险因素分析. 黑龙江医药科学, 2021, 44(6): 142-143.
24.	徐燕, 韩啸. 肺癌胸腔镜肺切除术后并发肺部感染的危险因素分析. 全科医学临床与教育, 2019, 17(11): 1010-1013.
25.	张东亚, 徐莉, 丁艳. 肺癌术后出现肺部感染患者的影响因素及其临床预防控制策略. 临床与病理杂志, 2021, 41(7): 1499-1504.
26.	张化芝, 郭晓烨, 李晓双, 等. 肺癌术后并发肺部感染的病原学分析及影响因素分析. 中华医院感染学杂志, 2018, 28(1): 77-80.
27.	张琦, 刘淑贤, 王立国, 等. 非小细胞肺癌患者术后肺部感染与致病性气道定植菌的关系. 解放军医药杂志, 2020, 32(9): 13-17.
28.	张宇星, 王宇, 宋伟伟, 等. 70岁以上老年非小细胞肺癌病人术后肺部感染的危险因素研究. 实用老年医学, 2019, 33(7): 661-665.
29.	诸静兰, 陈惠, 栾伟. 老年肺癌患者术后合并下呼吸道感染的相关因素分析. 国际肿瘤学杂志, 2016, 43(2): 95-98.
30.	朱瑞云, 孙仲文, 黄昌洋, 等. 肺癌患者术后并发肺部感染的危险因素分析. 循证医学, 2021, 21(6): 351-357.
31.	宋洋, 夏冰, 吴岳光. 肺癌患者肺部感染的相关临床危险因素分析. 中华全科医学, 2021, 19(3): 354-357, 462.
32.	杜斌. 腹部手术对呼吸功能的影响. 中国实用外科杂志, 2004, 24(3): 136-138.
33.	Klekotka RB, Mizgała E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
34.	许宗磊, 司明文, 冯桂青, 等. 心力衰竭患者肺部感染血浆脑钠肽与炎性因子的变化分析. 中华医院感染学杂志, 2015, 25(2): 250-252.
35.	戴芹, 方思, 郭红荣, 等. 老年肺癌患者术前气道定植菌及术后肺部并发症的危险因素分析. 武汉大学学报(医学版), 2022, 43(1): 122-127.
36.	Kim CH, Oh Y, Han K, et al. Expression of secreted mucins (MUC2, MUC5AC, MUC5B, and MUC6) and membrane-bound mucin (MUC4) in the lungs of pigs experimentally infected with Actinobacillus pleuropneumoniae. Res Vet Sci, 2012, 92(3): 486-491.
37.	周会, 蔡鹏, 周维富, 等. 胸外科围手术期抗生素的规范使用与术后感染病原菌耐药性分析. 现代预防医学, 2020, 47(10): 1892-1895.
38.	侯强, 杨滏宁, 董南, 等. 经胸腔镜肺癌切除术中行系统性淋巴结清扫术的价值. 实用癌症杂志, 2019, 34(4): 607-610.
39.	马建强, 杨绍军, 李旭, 等. 全胸腔镜与传统开胸肺癌根治术的比较. 中国微创外科杂志, 2016, 16(9): 802-806.
40.	中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
41.	李玲, 吴小妹. 机械通气患者肺部感染病原菌分布及其影响因素. 中国微生态学杂志, 2021, 33(4): 427-431.
42.	Kumar S, Jan RA, Fomda BA, et al. Healthcare-associated pneumonia and hospital-acquired pneumonia: Bacterial aetiology, antibiotic resistance and treatment outcomes: A study from North India. Lung, 2018, 196(4): 469-479.
43.	张苏, 李鹏, 张鹏, 等. 高龄肺癌患者真菌性肺炎的临床调查研究. 中华医院感染学杂志, 2015, 25(12): 2780-2781,2819.
44.	刘俪玭, 王小震, 吉喆, 等. 局部晚期非小细胞肺癌同步放化疗的治疗结果. 中华肿瘤杂志, 2015, 37(11): 863-867.
45.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
46.	江志伟. 加速康复外科学的概念与发展历史. 中华普通外科杂志, 2018, 33(8): 625-626.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. International agency for research on cancer world cancer report: Cancer research for cancer prevention. https://publications.iarc.fr/586. Accessed on 2022-02-10.
3. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
4. 曾宪涛, 刘慧, 陈曦, 等. Meta分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
5. Simonsen DF, Søgaard M, Bozi I, et al. Risk factors for postoperative pneumonia after lung cancer surgery and impact of pneumonia on survival. Respir Med, 2015, 109(10): 1340-1346.
6. Dupont G, Flory L, Morel J, et al. Postoperative lymphopenia: An independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study. PLoS One, 2018, 13(10): e0205237.
7. Liu GW, Sui XZ, Wang SD, et al. Identifying patients at higher risk of pneumonia after lung resection. J Thorac Dis, 2017, 9(5): 1289-1294.
8. Sarıçam M. Efficacy of preoperative white blood cell count and lymphocyte/monocyte ratio in predicting post-lobectomy pneumonia. Turk Gogus Kalp Damar Cerrahisi Derg, 2021, 29(1): 84-91.
9. Díaz-Ravetllat V, Ferrer M, Gimferrer-Garolera JM, et al. Risk factors of postoperative nosocomial pneumonia after resection of bronchogenic carcinoma. Respir Med, 2012, 106(10): 1463-1471.
10. Zhang X, Jin R, Zheng Y, et al. Interactions between the enhanced recovery after surgery pathway and risk factors for lung infections after pulmonary malignancy operation. Transl Lung Cancer Res, 2020, 9(5): 1831-1842.
11. 常涛, 张铸. 肺癌患者术后院内肺部感染的相关因素分析. 中国胸心血管外科临床杂志, 2013, 20(2): 176-180.
12. 李燕江. 胰腺癌根治术预后相关因素分析. 昆明医科大学, 2021.
13. 杜海侠, 赵冬峰, 黄国胜, 等. 非小细胞肺癌患者手术后并发肺炎的相关因素分析. 河南外科学杂志, 2021, 27(6): 66-68.
14. 葛宏飞, 林玲, 翁贤福, 等. 肺癌术后并发肺部感染病原学及危险因素分析. 浙江中西医结合杂志, 2016, 26(5): 498-500.
15. 耿秀丽, 李艳梅, 王樱洁. 肺癌患者术后合并肺部感染的临床特点及影响因素. 中国肿瘤临床与康复, 2019, 26(9): 1054-1057.
16. 韩颖, 彭威军, 魏诗晴, 等. 老年非小细胞肺癌患者术后肺炎危险因素. 中国感染控制杂志, 2019, 18(12): 1132-1136.
17. 林善安, 王晓军, 徐晓文, 等. 肺癌根治术患者围术期肺部感染的危险因素分析及预防措施. 西藏医药, 2020, 41(5): 46-47.
18. 刘东东, 沈剑, 黄思远, 等. 肺癌根治术后肺部感染的相关因素分析. 中华全科医学, 2021, 19(4): 550-553.
19. 彭彬, 李国锋, 许明明. 高龄肺癌根治术患者围术期肺部感染的高危因素分析及预防. 中国肿瘤临床与康复, 2018, 25(12): 1435-1438.
20. 彭武君, 张文林, 刘君德, 等. 气道定植菌对肺癌患者术后肺部感染的影响因素分析. 中华医院感染学杂志, 2019, 29(4): 508-511.
21. 万青梅. 老年肺癌患者术后并发肺部感染的危险因素分析及防治对策. 西南军医, 2014, 16(4): 398-399.
22. 王庆华, 蔡宏剑, 袁荣正, 等. 肺癌患者术后并发肺部感染的危险因素分析. 中国癌症防治杂志, 2020, 12(1): 95-99.
23. 王震. 肺癌患者术后肺部感染的现状、病原菌分布特点及其危险因素分析. 黑龙江医药科学, 2021, 44(6): 142-143.
24. 徐燕, 韩啸. 肺癌胸腔镜肺切除术后并发肺部感染的危险因素分析. 全科医学临床与教育, 2019, 17(11): 1010-1013.
25. 张东亚, 徐莉, 丁艳. 肺癌术后出现肺部感染患者的影响因素及其临床预防控制策略. 临床与病理杂志, 2021, 41(7): 1499-1504.
26. 张化芝, 郭晓烨, 李晓双, 等. 肺癌术后并发肺部感染的病原学分析及影响因素分析. 中华医院感染学杂志, 2018, 28(1): 77-80.
27. 张琦, 刘淑贤, 王立国, 等. 非小细胞肺癌患者术后肺部感染与致病性气道定植菌的关系. 解放军医药杂志, 2020, 32(9): 13-17.
28. 张宇星, 王宇, 宋伟伟, 等. 70岁以上老年非小细胞肺癌病人术后肺部感染的危险因素研究. 实用老年医学, 2019, 33(7): 661-665.
29. 诸静兰, 陈惠, 栾伟. 老年肺癌患者术后合并下呼吸道感染的相关因素分析. 国际肿瘤学杂志, 2016, 43(2): 95-98.
30. 朱瑞云, 孙仲文, 黄昌洋, 等. 肺癌患者术后并发肺部感染的危险因素分析. 循证医学, 2021, 21(6): 351-357.
31. 宋洋, 夏冰, 吴岳光. 肺癌患者肺部感染的相关临床危险因素分析. 中华全科医学, 2021, 19(3): 354-357, 462.
32. 杜斌. 腹部手术对呼吸功能的影响. 中国实用外科杂志, 2004, 24(3): 136-138.
33. Klekotka RB, Mizgała E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
34. 许宗磊, 司明文, 冯桂青, 等. 心力衰竭患者肺部感染血浆脑钠肽与炎性因子的变化分析. 中华医院感染学杂志, 2015, 25(2): 250-252.
35. 戴芹, 方思, 郭红荣, 等. 老年肺癌患者术前气道定植菌及术后肺部并发症的危险因素分析. 武汉大学学报(医学版), 2022, 43(1): 122-127.
36. Kim CH, Oh Y, Han K, et al. Expression of secreted mucins (MUC2, MUC5AC, MUC5B, and MUC6) and membrane-bound mucin (MUC4) in the lungs of pigs experimentally infected with Actinobacillus pleuropneumoniae. Res Vet Sci, 2012, 92(3): 486-491.
37. 周会, 蔡鹏, 周维富, 等. 胸外科围手术期抗生素的规范使用与术后感染病原菌耐药性分析. 现代预防医学, 2020, 47(10): 1892-1895.
38. 侯强, 杨滏宁, 董南, 等. 经胸腔镜肺癌切除术中行系统性淋巴结清扫术的价值. 实用癌症杂志, 2019, 34(4): 607-610.
39. 马建强, 杨绍军, 李旭, 等. 全胸腔镜与传统开胸肺癌根治术的比较. 中国微创外科杂志, 2016, 16(9): 802-806.
40. 中华医学会胸心血管外科学分会胸腔镜外科学组, 中国医师协会胸外科医师分会微创外科专家委员会. 中国胸外科围手术期疼痛管理专家共识(2018版). 中国胸心血管外科临床杂志, 2018, 25(11): 921-928.
41. 李玲, 吴小妹. 机械通气患者肺部感染病原菌分布及其影响因素. 中国微生态学杂志, 2021, 33(4): 427-431.
42. Kumar S, Jan RA, Fomda BA, et al. Healthcare-associated pneumonia and hospital-acquired pneumonia: Bacterial aetiology, antibiotic resistance and treatment outcomes: A study from North India. Lung, 2018, 196(4): 469-479.
43. 张苏, 李鹏, 张鹏, 等. 高龄肺癌患者真菌性肺炎的临床调查研究. 中华医院感染学杂志, 2015, 25(12): 2780-2781,2819.
44. 刘俪玭, 王小震, 吉喆, 等. 局部晚期非小细胞肺癌同步放化疗的治疗结果. 中华肿瘤杂志, 2015, 37(11): 863-867.
45. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
46. 江志伟. 加速康复外科学的概念与发展历史. 中华普通外科杂志, 2018, 33(8): 625-626.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative pulmonary infection in lung cancer patients: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content