Prasitlumkum Narut, Mekritthikrai Raktham, Kewcharoen Jakrin, Kanitsoraphan Chanavuth, Mao Michael A, Cheungpasitporn Wisit
Internal Medicine Residency Program, University of Hawaii, 1356 Lusitana St, Honolulu, HI, 96813, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Cardiovasc Interv Ther. 2020 Apr;35(2):168-176. doi: 10.1007/s12928-019-00592-y. Epub 2019 Jun 1.
Post-operative delirium (POD) has been recognized as an independent risk factor for mortality. Recent studies suggest that POD is associated with higher mortality rates in patients undergoing transcatheter aortic valve replacement (TAVR). However, a systematic review and meta-analysis of the literature has not been performed. This study assessed the association between POD and TAVR by performing a systematic review and meta-analysis of the literature. We comprehensively searched the databases of MEDLINE and EMBASE from inception to April 2018. Included studies were prospective or retrospective cohort studies that compared mortality among patients undergoing TAVR both with and without POD. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. Seven studies consisting of 20,086 subjects undergoing TAVR (1517 with POD and 18,569 without POD) were included in this meta-analysis. POD demonstrated a trend towards higher all-cause mortality (pooled odd ratio 1.52, 95% confidence interval 0.98-2.37, p = 0.062, I = 72%). POD was associated with a significant increased long-term mortality (pooled odd ratio 2.11, 95% confidence interval 1.21-3.68, p = 0.009, I = 62.5%). POD was associated with an increased risk of long-term all-cause mortality in patients undergoing TAVR. Our study suggests POD could be a potential risk factor of mortality among patients undergoing TAVR. Further studies implementing preventative and treatment strategies against delirium and its effect on POD and its associated mortality are needed.
术后谵妄（POD）已被确认为死亡率的独立危险因素。近期研究表明，POD与经导管主动脉瓣置换术（TAVR）患者的较高死亡率相关。然而，尚未对文献进行系统评价和荟萃分析。本研究通过对文献进行系统评价和荟萃分析，评估了POD与TAVR之间的关联。我们全面检索了MEDLINE和EMBASE数据库，检索时间从数据库建立至2018年4月。纳入的研究为前瞻性或回顾性队列研究，比较了有和无POD的TAVR患者的死亡率。采用DerSimonian和Laird的随机效应、通用逆方差法合并每项研究的数据，以计算风险比和95%置信区间。本荟萃分析纳入了7项研究，共20,086例接受TAVR的受试者（1517例有POD，18,569例无POD）。POD显示出全因死亡率升高的趋势（合并比值比1.52，95%置信区间0.98 - 2.37；p = 0.062，I² = 72%）。POD与长期死亡率显著升高相关（合并比值比2.11，95%置信区间1.21 - 3.68；p = 0.009，I² = 62.5%）。POD与接受TAVR患者的长期全因死亡风险增加相关。我们的研究表明，POD可能是接受TAVR患者死亡的潜在危险因素。需要进一步开展针对谵妄的预防和治疗策略及其对POD及其相关死亡率影响的研究。
