Gianluca DE Rubeis, Simone Zilahi DE Gyurgyokai, Sebastiano Fabiano, Luca Bertaccini, Andrea Wlderk, Francesca R Pezzella, Sabrina Anticoli, Giuseppe Biondi-Zoccai, Francesco Versaci, Luca Saba, Enrico Pampana
{"title":"在治疗中风和心肌梗死的血管内手术中,术中持续输注生理盐水可显著降低急性肾损伤的发生率:来自系统综述和元回归的证据。","authors":"Gianluca DE Rubeis, Simone Zilahi DE Gyurgyokai, Sebastiano Fabiano, Luca Bertaccini, Andrea Wlderk, Francesca R Pezzella, Sabrina Anticoli, Giuseppe Biondi-Zoccai, Francesco Versaci, Luca Saba, Enrico Pampana","doi":"10.23736/S0026-4806.23.09093-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI).</p><p><strong>Methods: </strong>A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates.</p><p><strong>Results: </strong>A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I<sup>2</sup>=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03).</p><p><strong>Conclusions: </strong>Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression.\",\"authors\":\"Gianluca DE Rubeis, Simone Zilahi DE Gyurgyokai, Sebastiano Fabiano, Luca Bertaccini, Andrea Wlderk, Francesca R Pezzella, Sabrina Anticoli, Giuseppe Biondi-Zoccai, Francesco Versaci, Luca Saba, Enrico Pampana\",\"doi\":\"10.23736/S0026-4806.23.09093-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI).</p><p><strong>Methods: </strong>A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates.</p><p><strong>Results: </strong>A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I<sup>2</sup>=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03).</p><p><strong>Conclusions: </strong>Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.</p>\",\"PeriodicalId\":94143,\"journal\":{\"name\":\"Minerva medica\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minerva medica\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.23736/S0026-4806.23.09093-6\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/4/2 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva medica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23736/S0026-4806.23.09093-6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/4/2 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:在治疗中风和心肌梗塞的机械疗法中使用的造影剂是急性内科情况下导致急性肾损伤(AKI)的一个重要原因。虽然连续生理盐水输注管(CSIL)是在机械血栓切除术(MT)的神经血管介入过程中防止导管内血栓形成的标准程序,但在经皮冠状动脉介入治疗(PCI)中并未使用:方法:对治疗中风的 MT 术后 AKI 发生率进行了系统回顾。方法:对 MT 治疗脑卒中后的 AKI 发生率进行了系统回顾,并将这些数据与文献报道的 PCI 治疗急性心肌梗死后的 AKI 发生率进行了比较。以临床细节为协变量,进行随机效应模型元回归,探讨 CSIL 对 AKI 发生率的影响:分别纳入了 18 项和 33 项关于 MT 和 PCI 的研究,共纳入了 69464 名患者(MT 患者为 30138 人 [43.4%],PCI 患者为 39326 人 [56.6%])。平均年龄为(63.6 岁±5.8)岁,男性为(66.6%±12.8)岁。慢性肾病患病率为 2.0-50.3%。糖尿病患病率为 11.1%-53.0%。吸烟率为7.5%-72.0%。事实证明,AKI的发生率变化很大(I2=98%,Cochrane's Q 2985),MT亚组的发生率明显低于PCI亚组(分别为8.3% [95%置信区间:4.7-11.9%] vs. 14.7 [12.6-16.8%],PC结论:在急诊血管内手术中使用 CSIL 可显著降低 AKI 风险,在此类干预中应常规考虑 CSIL 的安全性。
Intraprocedural continuous saline infusion lines significantly reduce the incidence of acute kidney injury during endovascular procedures for stroke and myocardial infarction: evidence from a systematic review and meta-regression.
Background: Contrast media used in mechanical therapies for stroke and myocardial infarction represent a significant cause of acute kidney injury (AKI) in acute medical scenarios. Although the continuous saline infusion line (CSIL) is a standard procedure to prevent thrombus formation within the catheter during neurovascular interventions of mechanical thrombectomy (MT), it is not utilized in percutaneous coronary interventions (PCI).
Methods: A systematic review of the incidence of AKI after MT for stroke treatment was performed. These data were compared with those reported in the literature regarding the incidence of AKI after PCI for acute myocardial infarction. A random-effect model meta-regression was performed to explore the effects of CSIL on AKI incidence, using clinical details as covariates.
Results: A total of 18 and 33 studies on MT and PCI were included, respectively, with 69,464 patients (30,138 [43.4%] for MT and 39,326 [56.6%] for PCI). The mean age was 63.6 years±5.8 with male 66.6%±12.8. Chronic kidney disease ranged 2.0-50.3%. Diabetes prevalence spanned 11.1% to 53.0%. Smoking status had a prevalence of 7.5-72.0%. Incidence of AKI proved highly variable (I2=98%, Cochrane's Q 2985), and appeared significantly lower in the MT subgroup than in the PCI subgroups (respectively 8.3% [95% confidence interval: 4.7-11.9%] vs. 14.7 [12.6-16.8%], P<0.05). Meta-regression showed that CSIL was significantly associated with a decreased incidence of AKI (OR=0.93 [1.001-1.16]; P=0.03).
Conclusions: Implementation of CSIL during endovascular procedures in acute settings was associated with a significant decrease in the risk of AKI, and its safety should be routinely considered in such interventions.