Glasmacher Stella Andrea, Stones William
Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, BN1 9PX, UK.
Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi.
BMC Res Notes. 2017 Nov 3;10(1):556. doi: 10.1186/s13104-017-2853-9.
This systematic review and meta-analysis seeks to determine the validity of the anion gap to screen for hyperlactatemia in critically ill patients. We have previously shown that the anion gap does not predict 31-day and in-hospital mortality in critically ill patients. The present review aims to add confirmatory evidence to identify whether the anion gap is a suitable tool for risk stratification in low-resource countries.
Nine studies reporting on 4504 samples from 2111 patients were included. The anion gap failed to detect hyperlactatemia defined as lactate above 2.5 mmol/l but showed good discriminatory ability for the detection of severe hyperlactatemia defined as lactate over 4 mmol/l. At the 2.5 mmol/l threshold, the anion gap had high specificity but low sensitivity for the detection of hyperlactatemia. A meta-analysis of correlation coefficients yielded high statistical heterogeneity. Therefore, in keeping with our previous findings, the use of the anion gap for risk stratification as an alternative to lactate cannot be recommended. However, the strength of the evidence we have synthesised is adversely affected by the small number of studies included, inconsistency of effect measures and positivity thresholds reported, and selection bias within individual studies. PROSPERO Registration Number: CRD42015016470 (registered on the 4th February 2015).
本系统评价和荟萃分析旨在确定阴离子间隙用于筛查危重症患者高乳酸血症的有效性。我们之前已经表明，阴离子间隙不能预测危重症患者的31天和住院死亡率。本评价旨在补充确证性证据，以确定阴离子间隙是否是资源匮乏国家进行风险分层的合适工具。
纳入了9项研究，报告了来自2111例患者的4504份样本。阴离子间隙未能检测出定义为乳酸水平高于2.5 mmol/L的高乳酸血症，但对检测定义为乳酸水平超过4 mmol/L的严重高乳酸血症具有良好的鉴别能力。在2.5 mmol/L的阈值下，阴离子间隙检测高乳酸血症时具有高特异性但低敏感性。相关系数的荟萃分析产生了高度的统计异质性。因此，与我们之前的研究结果一致，不建议使用阴离子间隙作为乳酸的替代指标进行风险分层。然而，我们综合的证据强度受到纳入研究数量少、报告的效应量和阳性阈值不一致以及个别研究中的选择偏倚的不利影响。PROSPERO注册号：CRD42015016470（于2015年2月4日注册）。
