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Meta-Analysis
. 2021 Feb 12;22(1):53.
doi: 10.1186/s12931-021-01650-x.

The role of viral and bacterial infections in the pathogenesis of IPF: a systematic review and meta-analysis

Shayan Mostafaei  1   2 , Babak Sayad  3 , Maryam Ebadi Fard Azar  4 , Mohammad Doroudian  5 , Shima Hadifar  6 , Ava Behrouzi  6 , Parisa Riahi  7 , Bashdar Mahmud Hussen  8 , Bahareh Bayat  9 , Javid Sadri Nahand  10 , Mohsen Moghoofei  11
Affiliations
Meta-Analysis

The role of viral and bacterial infections in the pathogenesis of IPF: a systematic review and meta-analysis

Shayan Mostafaei et al. Respir Res. .

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease. Several risk factors such as smoking, air pollution, inhaled toxins, high body mass index and infectious agents are involved in the pathogenesis of IPF. In the present study, this meta-analysis study investigates the prevalence of viral and bacterial infections in the IPF patients and any possible association between these infections with pathogenesis of IPF.

Methods: The authors carried out this systematic literature review from different reliable databases such as PubMed, ISI Web of Science, Scopus and Google Scholar to December 2020.Keywords used were the following "Idiopathic pulmonary fibrosis", "Infection", "Bacterial Infection" and "Viral Infection", alone or combined together with the Boolean operators "OR", "AND" and "NOT" in the Title/Abstract/Keywords field. Pooled proportion and its 95% CI were used to assess the prevalence of viral and bacterial infections in the IPF patients.

Results: In this systematic review and meta-analyses, 32 studies were selected based on the exclusion/inclusion criteria. Geographical distribution of included studies was: eight studies in American people, 8; in European people, 15 in Asians, and one in Africans. The pooled prevalence for viral and bacterial infections w ere 53.72% (95% CI 38.1-69.1%) and 31.21% (95% CI 19.9-43.7%), respectively. The highest and lowest prevalence of viral infections was HSV (77.7% 95% CI 38.48-99.32%), EBV (72.02%, 95% CI 44.65-90.79%) and Influenza A (7.3%, 95% CI 2.66-42.45%), respectively. Whereas the highest and lowest prevalence in bacterial infections were related to Streptococcus sp. (99.49%, 95% CI 96.44-99.9%) and Raoultella (1.2%, 95% CI 0.2-3.08%), respectively.

Conclusions: The results of this review were confirmed that the presence of viral and bacterial infections are the risk factors in the pathogenesis of IPF. In further analyses, which have never been shown in the previous studies, we revealed the geographic variations in the association strengths and emphasized other methodological parameters (e.g., detection method). Also, our study supports the hypothesis that respiratory infection could play a key role in the pathogenesis of IP.

Keywords: Bacterial infection; Epidemiology; Idiopathic pulmonary fibrosis; Meta-analysis; Viral infection.

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Conflict of interest statement

The authors declare that they have no conflicting interests.

Figures

Fig. 1
Fig. 1
Search flow diagram for 32 studies included in the meta-analysis
Fig. 2
Fig. 2
Forest plot of pooled prevalence of viral and bacterial infections in the IPF patients
Fig. 3
Fig. 3
Forest plot of subgroup analysis for the pooled prevalence of viral and bacterial infections in the IPF patients based on the ranges of year of publication
Fig. 4
Fig. 4
Trend plot of logit (logarithm of odds ratio between the infections and non-infection) of viral and bacterial infections over age of the IPF patients (P-value = 0.048)
Fig. 5
Fig. 5
Funnel plot to detect publication bias (Begg’s p-value = 0.041, Egger’s p-value = 0.046)
Fig. 6
Fig. 6
Baujat plot to detect the studies overly contributing to the heterogeneity of this meta-analysis
See this image and copyright information in PMC

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