Bellos Ioannis, Iliopoulos Dimitrios C, Perrea Despina N
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Pediatr Nephrol. 2020 Jun;35(6):1109-1119. doi: 10.1007/s00467-020-04489-4. Epub 2020 Feb 10.
Pediatric cardiac surgery is commonly associated with acute kidney injury (AKI) and significant fluid retention, which complicate postoperative management and lead to increased rates of morbidity. This meta-analysis aimed to accumulate current literature evidence and evaluate the correlation of fluid overload degree with adverse outcome in patients undergoing congenital heart surgery.
Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar were systematically searched from inception. All studies reporting the effects of fluid overload on postoperative clinical outcomes were selected. A dose-response meta-analytic method using restricted cubic splines was implemented in R-3.6.1.
Twelve studies were included, with a total of 3111 pediatric patients. Qualitative synthesis indicated that fluid overload was linked to significantly higher risk of mortality, AKI, prolonged hospital, and intensive care unit (ICU) stay, as well as with increased duration of mechanical ventilation, inotrope need, and infection rate. Meta-analysis demonstrated a linear correlation between fluid overload and the risk of mortality (χ = 6.22, p value = 0.01) and AKI (χ = 35.84, p value < 0.001), while a positive curvilinear relationship was estimated for the outcomes of hospital (χ = 18.84, p value = 0.0001) and ICU stay (χ = 63.69, p value = 0.0001).
The present meta-analysis supports that postoperative fluid overload is significantly linked to elevated risk of prolonged hospital stay, AKI development, and mortality in pediatric patients undergoing cardiac surgery. These findings warrant replication by future prospective studies, which should define the optimal cutoff values and assess the effectiveness of therapeutic strategies to limit fluid overload in the postoperative setting.
小儿心脏手术常伴有急性肾损伤（AKI）和大量液体潴留，这使术后管理复杂化并导致发病率增加。本荟萃分析旨在积累当前文献证据，并评估先天性心脏病手术患者液体超负荷程度与不良结局之间的相关性。
从创刊起对Medline、Scopus、CENTRAL、Clinicaltrials.gov和谷歌学术进行系统检索。选择所有报告液体超负荷对术后临床结局影响的研究。在R-3.6.1中采用使用受限立方样条的剂量反应荟萃分析方法。
纳入12项研究，共3111例儿科患者。定性综合分析表明，液体超负荷与死亡、AKI、住院时间延长、重症监护病房（ICU）住院时间延长以及机械通气时间延长、血管活性药物需求增加和感染率升高的风险显著相关。荟萃分析表明液体超负荷与死亡风险（χ = 6.22，p值 = 0.01）和AKI（χ = 35.84，p值 < 0.001）之间存在线性相关性，而对于住院（χ = 18.84，p值 = 0.0001）和ICU住院时间（χ = 63.69，p值 = 0.0001）的结局估计存在正曲线关系。
本荟萃分析支持术后液体超负荷与接受心脏手术的儿科患者住院时间延长、发生AKI和死亡风险升高显著相关。这些发现有待未来前瞻性研究进行重复验证，前瞻性研究应确定最佳临界值并评估限制术后液体超负荷的治疗策略的有效性。
