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Meta-Analysis
. 2024 Jun;52(3):1009-1026.
doi: 10.1007/s15010-023-02156-y. Epub 2024 Jan 18.

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Maren Steinmann  1 , David Lampe  2 , John Grosser  2 , Juliana Schmidt  2 , Marla Louise Hohoff  2 , Anita Fischer  2 , Wolfgang Greiner  2
Affiliations
Meta-Analysis

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

Maren Steinmann et al. Infection. 2024 Jun.

Abstract

Purpose: The burden of herpes zoster (HZ) is substantial and numerous chronic underlying conditions are known as predisposing risk factors for HZ onset. Thus, a comprehensive study is needed to synthesize existing evidence. This study aims to comprehensively identify these risk factors.

Methods: A systematic literature search was done using MEDLINE via PubMed, EMBASE and Web of Science for studies published from January 1, 2003 to January 1, 2023. A random-effects model was used to estimate pooled Odds Ratios (OR). Heterogeneity was assessed using the I2 statistic. For sensitivity analyses basic outlier removal, leave-one-out validation and Graphic Display of Heterogeneity (GOSH) plots with different algorithms were employed to further analyze heterogeneity patterns. Finally, a multiple meta-regression was conducted.

Results: Of 6392 considered records, 80 were included in the meta-analysis. 21 different conditions were identified as potential risk factors for HZ: asthma, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), depression, diabetes, digestive disorders, endocrine and metabolic disorders, hematological disorders, HIV, inflammatory bowel disease (IBD), mental health conditions, musculoskeletal disorders, neurological disorders, psoriasis, renal disorders, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and transplantation. Transplantation was associated with the highest risk of HZ (OR = 4.51 (95% CI [1.9-10.7])). Other risk factors ranged from OR = 1.17-2.87, indicating an increased risk for all underlying conditions. Heterogeneity was substantial in all provided analyses. Sensitivity analyses showed comparable results regarding the pooled effects and heterogeneity.

Conclusions: This study showed an increased risk of HZ infections for all identified factors.

Keywords: Herpes zoster; Meta-analysis; Meta-regression; Random-effects model; Risk factors; Systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart
Fig. 2
Fig. 2
Pooled analysis for risk of herpes zoster
Fig. 3
Fig. 3
Forest plot for risk of herpes zoster in transplantation subgroup. The transplantation subgroup summarizes allogenic, bone marrow, (solid) organ and hematopoietic stem cell transplantation
Fig. 4
Fig. 4
Forest plot for risk of herpes zoster in cancer subgroup. The cancer subgroup summarizes any solid malignancy, hematological malignancies, solid organ malignancies, brain tumor, lung cancer, breast cancer, esophageal cancer, gastric cancer, colorectal cancer, gynecologic cancer and malignant lymphoma
See this image and copyright information in PMC

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