Rafael Hortêncio Melo, Luciana Gioli-Pereira, Edielle Melo, Philippe Rola
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The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Publication bias was assessed via funnel plot and heterogeneity was examined with I<sup>2</sup> statistics.</p><p><strong>Results: </strong>Our analysis included 1036 patients from nine studies, of whom 17.4% presented venous congestion according to VExUS definition. In critically ill patients presenting with venous congestion (VExUS score ≥ 2), the incidence of AKI was significantly higher as compared with those without congestion (OR 2.63, 95% CI 1.06-6.54; p = 0.04; I<sup>2</sup> = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32-6.42; p < 0.00001; i<sup>2</sup> = 0%). 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引用次数: 0
摘要
背景：通过静脉过量超声评分（VExUS）评估的全身静脉充血与心脏手术患者的急性肾损伤（AKI）有关。然而，在一般危重病人中缺乏这种关联的证据。研究设计和方法：检索PubMed、Embase和Cochrane数据库，纳入危重患者的观察性前瞻性研究，并分析重症监护病房入院第一天的VExUS评分。主要观察指标为AKI的发生。次要终点是全因死亡率。使用Review Manager 5.4.1进行统计分析。使用随机效应模型合并95%置信区间的优势比（OR）。预后质量研究（QUIPS）工具用于评估偏倚风险。采用漏斗图评价发表偏倚，采用I2统计量检验异质性。结果：我们的分析包括来自9项研究的1036例患者，其中17.4%的患者根据VExUS的定义出现静脉充血。在出现静脉充血（VExUS评分≥2）的危重患者中，AKI的发生率明显高于无充血的患者(OR 2.63, 95% CI 1.06-6.54；p = 0.04；i2 = 74%)。心脏手术患者的相关性更强(OR 3.86, 95% CI 2.32-6.42；p 2 = 0%)。静脉充血与全因死亡率无显著相关性(OR 1.25, 95% CI 0.71-2.19；p = 0.44；i2 = 8%)。结论：这些发现表明，在危重患者中，VExUS评分可能与AKI发生率升高相关，在接受心脏手术的患者亚组中观察到更明显的影响。在VExUS评分和全因死亡率之间没有统计学上的显著关联。临床试验注册：PROSPERO，协议号CRD535513。
Venous excess ultrasound score association with acute kidney injury in critically ill patients: a systematic review and meta-analysis of observational studies.
Background: Systemic venous congestion assessed by the venous excess ultrasound score (VExUS), has been associated with acute kidney injury (AKI) in patients undergoing cardiac surgery. However, there is a lack of evidence of this association in the general critically ill patients.
Study design and methods: PubMed, Embase, and Cochrane databases were searched for observational prospective studies that included critically ill patients and analyzed VExUS score on the first day of admission to the ICU. The main outcome was occurrence of AKI. Secondary outcome was all-cause mortality. Statistical analysis was performed using Review Manager 5.4.1. Odds ratios (OR) with 95% confidence interval were pooled using a random-effects model. The Quality in Prognosis Studies (QUIPS) tool was used to assess risk of bias. Publication bias was assessed via funnel plot and heterogeneity was examined with I2 statistics.
Results: Our analysis included 1036 patients from nine studies, of whom 17.4% presented venous congestion according to VExUS definition. In critically ill patients presenting with venous congestion (VExUS score ≥ 2), the incidence of AKI was significantly higher as compared with those without congestion (OR 2.63, 95% CI 1.06-6.54; p = 0.04; I2 = 74%). The association was notably stronger in cardiac surgery patients (OR 3.86, 95% CI 2.32-6.42; p < 0.00001; i2 = 0%). There was no significant association between venous congestion and all-cause mortality (OR 1.25, 95% CI 0.71-2.19; p = 0.44; i2 = 8%).
Conclusions: These findings suggest that VExUS score may correlate with an elevation in the incidence AKI in critically ill patients, with a more pronounced effect observed within the subgroup of patients undergoing cardiac surgery. There was no statistically significant association between VExUS score and all-cause mortality.
Clinical trial registration: PROSPERO under protocol number CRD535513.
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