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：

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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

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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.	曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
5.	Simonsen DF, S?gaard 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.	Sar??am 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.
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12.	李燕江. 胰腺癌根治術預后相關因素分析. 昆明醫科大學, 2021.
13.	杜海俠, 趙冬峰, 黃國勝, 等. 非小細胞肺癌患者手術后并發肺炎的相關因素分析. 河南外科學雜志, 2021, 27(6): 66-68.
14.	葛宏飛, 林玲, 翁賢福, 等. 肺癌術后并發肺部感染病原學及危險因素分析. 浙江中西醫結合雜志, 2016, 26(5): 498-500.
15.	耿秀麗, 李艷梅, 王櫻潔. 肺癌患者術后合并肺部感染的臨床特點及影響因素. 中國腫瘤臨床與康復, 2019, 26(9): 1054-1057.
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19.	彭彬, 李國鋒, 許明明. 高齡肺癌根治術患者圍術期肺部感染的高危因素分析及預防. 中國腫瘤臨床與康復, 2018, 25(12): 1435-1438.
20.	彭武君, 張文林, 劉君德, 等. 氣道定植菌對肺癌患者術后肺部感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(4): 508-511.
21.	萬青梅. 老年肺癌患者術后并發肺部感染的危險因素分析及防治對策. 西南軍醫, 2014, 16(4): 398-399.
22.	王慶華, 蔡宏劍, 袁榮正, 等. 肺癌患者術后并發肺部感染的危險因素分析. 中國癌癥防治雜志, 2020, 12(1): 95-99.
23.	王震. 肺癌患者術后肺部感染的現狀、病原菌分布特點及其危險因素分析. 黑龍江醫藥科學, 2021, 44(6): 142-143.
24.	徐燕, 韓嘯. 肺癌胸腔鏡肺切除術后并發肺部感染的危險因素分析. 全科醫學臨床與教育, 2019, 17(11): 1010-1013.
25.	張東亞, 徐莉, 丁艷. 肺癌術后出現肺部感染患者的影響因素及其臨床預防控制策略. 臨床與病理雜志, 2021, 41(7): 1499-1504.
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27.	張琦, 劉淑賢, 王立國, 等. 非小細胞肺癌患者術后肺部感染與致病性氣道定植菌的關系. 解放軍醫藥雜志, 2020, 32(9): 13-17.
28.	張宇星, 王宇, 宋偉偉, 等. 70歲以上老年非小細胞肺癌病人術后肺部感染的危險因素研究. 實用老年醫學, 2019, 33(7): 661-665.
29.	諸靜蘭, 陳惠, 欒偉. 老年肺癌患者術后合并下呼吸道感染的相關因素分析. 國際腫瘤學雜志, 2016, 43(2): 95-98.
30.	朱瑞云, 孫仲文, 黃昌洋, 等. 肺癌患者術后并發肺部感染的危險因素分析. 循證醫學, 2021, 21(6): 351-357.
31.	宋洋, 夏冰, 吳岳光. 肺癌患者肺部感染的相關臨床危險因素分析. 中華全科醫學, 2021, 19(3): 354-357, 462.
32.	杜斌. 腹部手術對呼吸功能的影響. 中國實用外科雜志, 2004, 24(3): 136-138.
33.	Klekotka RB, Mizga?a E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
34.	許宗磊, 司明文, 馮桂青, 等. 心力衰竭患者肺部感染血漿腦鈉肽與炎性因子的變化分析. 中華醫院感染學雜志, 2015, 25(2): 250-252.
35.	戴芹, 方思, 郭紅榮, 等. 老年肺癌患者術前氣道定植菌及術后肺部并發癥的危險因素分析. 武漢大學學報(醫學版), 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.	周會, 蔡鵬, 周維富, 等. 胸外科圍手術期抗生素的規范使用與術后感染病原菌耐藥性分析. 現代預防醫學, 2020, 47(10): 1892-1895.
38.	侯強, 楊滏寧, 董南, 等. 經胸腔鏡肺癌切除術中行系統性淋巴結清掃術的價值. 實用癌癥雜志, 2019, 34(4): 607-610.
39.	馬建強, 楊紹軍, 李旭, 等. 全胸腔鏡與傳統開胸肺癌根治術的比較. 中國微創外科雜志, 2016, 16(9): 802-806.
40.	中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
41.	李玲, 吳小妹. 機械通氣患者肺部感染病原菌分布及其影響因素. 中國微生態學雜志, 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.	張蘇, 李鵬, 張鵬, 等. 高齡肺癌患者真菌性肺炎的臨床調查研究. 中華醫院感染學雜志, 2015, 25(12): 2780-2781,2819.
44.	劉儷玭, 王小震, 吉喆, 等. 局部晚期非小細胞肺癌同步放化療的治療結果. 中華腫瘤雜志, 2015, 37(11): 863-867.
45.	Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
46.	江志偉. 加速康復外科學的概念與發展歷史. 中華普通外科雜志, 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. 曾憲濤, 劉慧, 陳曦, 等. Meta分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
5. Simonsen DF, S?gaard 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. Sar??am 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. 常濤, 張鑄. 肺癌患者術后院內肺部感染的相關因素分析. 中國胸心血管外科臨床雜志, 2013, 20(2): 176-180.
12. 李燕江. 胰腺癌根治術預后相關因素分析. 昆明醫科大學, 2021.
13. 杜海俠, 趙冬峰, 黃國勝, 等. 非小細胞肺癌患者手術后并發肺炎的相關因素分析. 河南外科學雜志, 2021, 27(6): 66-68.
14. 葛宏飛, 林玲, 翁賢福, 等. 肺癌術后并發肺部感染病原學及危險因素分析. 浙江中西醫結合雜志, 2016, 26(5): 498-500.
15. 耿秀麗, 李艷梅, 王櫻潔. 肺癌患者術后合并肺部感染的臨床特點及影響因素. 中國腫瘤臨床與康復, 2019, 26(9): 1054-1057.
16. 韓穎, 彭威軍, 魏詩晴, 等. 老年非小細胞肺癌患者術后肺炎危險因素. 中國感染控制雜志, 2019, 18(12): 1132-1136.
17. 林善安, 王曉軍, 徐曉文, 等. 肺癌根治術患者圍術期肺部感染的危險因素分析及預防措施. 西藏醫藥, 2020, 41(5): 46-47.
18. 劉東東, 沈劍, 黃思遠, 等. 肺癌根治術后肺部感染的相關因素分析. 中華全科醫學, 2021, 19(4): 550-553.
19. 彭彬, 李國鋒, 許明明. 高齡肺癌根治術患者圍術期肺部感染的高危因素分析及預防. 中國腫瘤臨床與康復, 2018, 25(12): 1435-1438.
20. 彭武君, 張文林, 劉君德, 等. 氣道定植菌對肺癌患者術后肺部感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(4): 508-511.
21. 萬青梅. 老年肺癌患者術后并發肺部感染的危險因素分析及防治對策. 西南軍醫, 2014, 16(4): 398-399.
22. 王慶華, 蔡宏劍, 袁榮正, 等. 肺癌患者術后并發肺部感染的危險因素分析. 中國癌癥防治雜志, 2020, 12(1): 95-99.
23. 王震. 肺癌患者術后肺部感染的現狀、病原菌分布特點及其危險因素分析. 黑龍江醫藥科學, 2021, 44(6): 142-143.
24. 徐燕, 韓嘯. 肺癌胸腔鏡肺切除術后并發肺部感染的危險因素分析. 全科醫學臨床與教育, 2019, 17(11): 1010-1013.
25. 張東亞, 徐莉, 丁艷. 肺癌術后出現肺部感染患者的影響因素及其臨床預防控制策略. 臨床與病理雜志, 2021, 41(7): 1499-1504.
26. 張化芝, 郭曉燁, 李曉雙, 等. 肺癌術后并發肺部感染的病原學分析及影響因素分析. 中華醫院感染學雜志, 2018, 28(1): 77-80.
27. 張琦, 劉淑賢, 王立國, 等. 非小細胞肺癌患者術后肺部感染與致病性氣道定植菌的關系. 解放軍醫藥雜志, 2020, 32(9): 13-17.
28. 張宇星, 王宇, 宋偉偉, 等. 70歲以上老年非小細胞肺癌病人術后肺部感染的危險因素研究. 實用老年醫學, 2019, 33(7): 661-665.
29. 諸靜蘭, 陳惠, 欒偉. 老年肺癌患者術后合并下呼吸道感染的相關因素分析. 國際腫瘤學雜志, 2016, 43(2): 95-98.
30. 朱瑞云, 孫仲文, 黃昌洋, 等. 肺癌患者術后并發肺部感染的危險因素分析. 循證醫學, 2021, 21(6): 351-357.
31. 宋洋, 夏冰, 吳岳光. 肺癌患者肺部感染的相關臨床危險因素分析. 中華全科醫學, 2021, 19(3): 354-357, 462.
32. 杜斌. 腹部手術對呼吸功能的影響. 中國實用外科雜志, 2004, 24(3): 136-138.
33. Klekotka RB, Mizga?a E, Król W. The etiology of lower respiratory tract infections in people with diabetes. Pneumonol Alergol Pol, 2015, 83(5): 401-408.
34. 許宗磊, 司明文, 馮桂青, 等. 心力衰竭患者肺部感染血漿腦鈉肽與炎性因子的變化分析. 中華醫院感染學雜志, 2015, 25(2): 250-252.
35. 戴芹, 方思, 郭紅榮, 等. 老年肺癌患者術前氣道定植菌及術后肺部并發癥的危險因素分析. 武漢大學學報(醫學版), 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. 周會, 蔡鵬, 周維富, 等. 胸外科圍手術期抗生素的規范使用與術后感染病原菌耐藥性分析. 現代預防醫學, 2020, 47(10): 1892-1895.
38. 侯強, 楊滏寧, 董南, 等. 經胸腔鏡肺癌切除術中行系統性淋巴結清掃術的價值. 實用癌癥雜志, 2019, 34(4): 607-610.
39. 馬建強, 楊紹軍, 李旭, 等. 全胸腔鏡與傳統開胸肺癌根治術的比較. 中國微創外科雜志, 2016, 16(9): 802-806.
40. 中華醫學會胸心血管外科學分會胸腔鏡外科學組, 中國醫師協會胸外科醫師分會微創外科專家委員會. 中國胸外科圍手術期疼痛管理專家共識(2018版). 中國胸心血管外科臨床雜志, 2018, 25(11): 921-928.
41. 李玲, 吳小妹. 機械通氣患者肺部感染病原菌分布及其影響因素. 中國微生態學雜志, 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. 張蘇, 李鵬, 張鵬, 等. 高齡肺癌患者真菌性肺炎的臨床調查研究. 中華醫院感染學雜志, 2015, 25(12): 2780-2781,2819.
44. 劉儷玭, 王小震, 吉喆, 等. 局部晚期非小細胞肺癌同步放化療的治療結果. 中華腫瘤雜志, 2015, 37(11): 863-867.
45. Wilmore DW, Kehlet H. Management of patients in fast track surgery. BMJ, 2001, 322(7284): 473-476.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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

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