Department of Gastroenterology, Heart & Lung Centre, Wolverhampton, United Kingdom.
Department of Gastroenterology, Heart & Lung Centre, Wolverhampton, United Kingdom.
Ann Thorac Surg. 2019 Dec;108(6):1840-1848. doi: 10.1016/j.athoracsur.2019.04.108. Epub 2019 Jun 21.
Preoperative anemia is common in patients scheduled for cardiac surgery. However, its effect on postoperative outcomes remains controversial. This meta-analysis aimed to clarify the impact of anemia on outcomes after cardiac surgery.
A literature search was conducted on MEDLINE, Embase, Cochrane, and Web of Science databases. The primary outcome was 30-day postoperative or in-hospital mortality. Secondary outcomes included acute kidney injury, stroke, blood transfusion, and infection. A meta-analytic model was used to determine the differences in the above postoperative outcomes between anemic and nonanemic patients.
Of 1103 studies screened, 22 met the inclusion criteria. Of 114,277 patients, 23,624 (20.6%) were anemic. Anemia was associated with increased mortality (odds ratio [OR], 2.74; 95% confidence interval [CI], 2.32-3.24; I = 69.6%; P < .001), acute kidney injury (OR, 3.13; 95% CI, 2.37-4.12; I = 71.1%; P < .001), stroke (OR, 1.46; 95% CI, 1.24-1.72; I = 21.6%; P < .001), and infection (OR, 2.65; 95% CI, 1.98-3.55; I = 46.7%; P < .001). More anemic patients were transfused than nonanemic patients (33.3% vs 11.9%, respectively). No statistically significant association was found between mortality and blood transfusion (OR, 1.35; 95% CI, 0.92-1.98; I = 83.7%; P = .12), but we were not able to compare mortality with or without transfusion in those who were or were not anemic.
Preoperative anemia is associated with adverse outcomes after cardiac surgery. These findings support the addition of preoperative anemia to future risk prediction models and as a target for risk modification.
术前贫血在拟行心脏手术的患者中很常见。然而，其对术后结局的影响仍存在争议。本荟萃分析旨在阐明贫血对心脏手术后结局的影响。
对 MEDLINE、Embase、Cochrane 和 Web of Science 数据库进行文献检索。主要结局为术后 30 天或住院期间的死亡率。次要结局包括急性肾损伤、卒中和感染。采用荟萃分析模型确定贫血和非贫血患者上述术后结局的差异。
在筛选的 1103 项研究中，有 22 项符合纳入标准。在 114277 名患者中，有 23624 名（20.6%）为贫血患者。贫血与死亡率增加相关（比值比[OR]，2.74；95%置信区间[CI]，2.32-3.24；I=69.6%；P<.001）、急性肾损伤（OR，3.13；95% CI，2.37-4.12；I=71.1%；P<.001）、卒中和感染（OR，1.46；95% CI，1.24-1.72；I=21.6%；P<.001）。与非贫血患者相比，更多贫血患者需要输血（分别为 33.3%和 11.9%）。死亡率与输血之间无统计学显著相关性（OR，1.35；95% CI，0.92-1.98；I=83.7%；P=.12），但我们无法比较贫血患者和非贫血患者输血与未输血的死亡率。
术前贫血与心脏手术后不良结局相关。这些发现支持将术前贫血纳入未来的风险预测模型，并作为风险修正的目标。
