Mortality and risk factors in hospitalised adult patients with tetanus: a systematic review and meta-analysis.

Abstract

Tetanus is associated with very high mortality, but there is currently no consensus on the mortality and risk factors for hospitalised adult patients with tetanus. Therefore, we conducted this systematic review and meta-analysis to explore the mortality and associated risk factors in hospitalised adult patients with tetanus. Systematic review and meta-analysis. PubMed, Web of Science, The Cochrane Library and Embase, covering the period from 1 January 2000 to 5 February 2024. Observational studies with a focus on the mortality and associated risk factors in hospitalised adult patients with tetanus. Two researchers independently reviewed the studies and extracted the data. The pooled effect sizes for mortality and the total number of hospitalised patients with tetanus were calculated, along with the overall pooled mortality and corresponding 95% CI. Risk factors for mortality were determined using relative risk (RR) and 95% CI. The I² statistic was calculated to describe heterogeneity between studies. Additionally, subgroup and meta-regression analyses were carried out to further explore potential sources of heterogeneity. All statistical analyses were conducted via StataSE V.15.0. A total of 22 studies were included, comprising 1618 hospitalised adult patients with tetanus. The overall mortality among hospitalised adult patients with tetanus was 32.0% (95% CI: 27.1% to 37.0%). Six risk factors associated with mortality in these patients were identified, including age ≥40 years (RR=1.89, 95% CI: 1.37 to 2.61), incubation period <7 days (RR=2.10, 95% CI: 1.47 to 3.00), onset period <2 days (RR=2.06, 95% CI: 1.30 to 3.29), Ablett classification ≥III (RR=3.40, 95% CI: 1.91 to 6.05), presence of autonomic dysfunction (RR=4.84, 95% CI: 2.36 to 9.94) and the need for mechanical ventilation (RR=2.46, 95% CI: 1.48 to 4.09). The study findings have important implications for clinical practice and public health policy. The high mortality underscored the urgent need to strengthen tetanus prevention strategies, particularly by increasing vaccination coverage and enhancing wound care education in adults aged ≥40 years. The six identified mortality risk factors provided a framework for early risk stratification and targeted interventions in hospitalised patients with tetanus. Meanwhile, more well-designed, large-scale studies are needed for further validation and exploration. CRD42024533554.