经导管主动脉瓣植入术患者衰弱的测量和预后：系统评价和荟萃分析。
Measurement and prognosis of frail patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis.
机构信息
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Department of Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada.
出版信息
BMJ Open. 2021 Mar 4;11(3):e040459. doi: 10.1136/bmjopen-2020-040459.
OBJECTIVES
Our objectives were to review the literature to identify frailty instruments in use for transcatheter aortic valve implantation (TAVI) recipients and synthesise prognostic data from these studies, in order to inform clinical management of frail patients undergoing TAVI.
METHODS
We systematically reviewed the literature published in 2006 or later. We included studies of patients with aortic stenosis, diagnosed as frail, who underwent a TAVI procedure that reported mortality or clinical outcomes. We categorised the frailty instruments and reported on the prevalence of frailty in each study. We summarised the frequency of clinical outcomes and pooled outcomes from multiple studies. We explored heterogeneity and performed subgroup analysis, where possible. We also used Grading of Recommendations, Assessment, Development and Evaluation (GRADE) to assess the overall certainty of the estimates.
RESULTS
Of 49 included studies, 21 used single-dimension measures to assess frailty, 3 used administrative data-based measures, and 25 used multidimensional measures. Prevalence of frailty ranged from 5.67% to 90.07%. Albumin was the most commonly used single-dimension frailty measure and the Fried or modified Fried phenotype were the most commonly used multidimensional measures. Meta-analyses of studies that used either the Fried or modified Fried phenotype showed a 30-day mortality of 7.86% (95% CI 5.20% to 11.70%) and a 1-year mortality of 26.91% (95% CI 21.50% to 33.11%). The GRADE system suggests very low certainty of the respective estimates.
CONCLUSIONS
Frailty instruments varied across studies, leading to a wide range of frailty prevalence estimates for TAVI recipients and substantial heterogeneity. The results provide clinicians, patients and healthcare administrators, with potentially useful information on the prognosis of frail patients undergoing TAVI. This review highlights the need for standardisation of frailty measurement to promote consistency.
PROSPERO REGISTRATION NUMBER
CRD42018090597.
目的
本研究旨在系统回顾经导管主动脉瓣置换术（TAVI）患者中使用的衰弱评估工具的相关文献，并综合这些研究的预后数据，为 TAVI 术后衰弱患者的临床管理提供信息。
方法
我们系统地检索了 2006 年或之后发表的文献。我们纳入了接受 TAVI 且被诊断为衰弱的主动脉瓣狭窄患者的研究，并报告了死亡率或临床结局。我们对衰弱评估工具进行分类，并报告了每个研究中的衰弱发生率。我们总结了临床结局的频率，并对多个研究的结局进行了汇总。如果可能的话，我们还进行了异质性分析和亚组分析。我们还使用推荐评估、制定与评价分级（GRADE）系统评估了估计的总体确定性。
结果
在纳入的 49 项研究中，21 项研究使用单维度评估工具来评估衰弱，3 项研究使用基于行政数据的评估工具，25 项研究使用多维评估工具。衰弱的发生率范围为 5.67%至 90.07%。白蛋白是最常用的单维度衰弱评估工具，而 Fried 或改良 Fried 表型是最常用的多维评估工具。使用 Fried 或改良 Fried 表型的研究的荟萃分析显示，30 天死亡率为 7.86%（95%CI 5.20%至 11.70%），1 年死亡率为 26.91%（95%CI 21.50%至 33.11%）。GRADE 系统提示各自估计的确定性非常低。
结论
不同研究中衰弱评估工具存在差异，导致 TAVI 患者衰弱发生率的估计值差异较大，且存在较大的异质性。研究结果为接受 TAVI 的衰弱患者的预后提供了潜在有用的信息，可供临床医生、患者和医疗保健管理人员参考。本综述强调了衰弱测量标准化的必要性，以促进一致性。
PROSPERO 注册号：CRD42018090597。
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