Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
Br J Anaesth. 2021 Sep;127(3):365-375. doi: 10.1016/j.bja.2021.04.032. Epub 2021 Jul 3.
It is unclear whether the innate immune response represents a therapeutic target for organ protection strategies in cardiac surgery.
A systematic review of trials of interventions targeting the inflammatory response to cardiac surgery reporting treatment effects on both innate immune system cytokines and organ injury was performed. The protocol was registered at the International Prospective Register of Systematic Reviews: CRD42020187239. Searches of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were performed. Random-effects meta-analyses were used for the primary analysis. A separate analysis of individual patient data from six studies (n=785) explored sources of heterogeneity for treatment effects on cytokine levels.
Searches to May 2020 identified 251 trials evaluating 24 interventions with 20 582 participants for inclusion. Most trials had important limitations. Methodological limitations of the included trials and heterogeneity of the treatment effects on cytokine levels between trials limited interpretation. The primary analysis demonstrated inconsistency in the direction of the treatment effects on innate immunity and organ failure or death between interventions. Analyses restricted to important subgroups or trials with fewer limitations showed similar results. Meta-regression, pooling available data from all trials, demonstrated no association between the direction of the treatment effects on inflammatory cytokines and organ injury or death. The analysis of individual patient data demonstrated heterogeneity in the association between the cytokine response and organ injury after cardiac surgery for people >75 yr old and those with some chronic diseases.
The certainty of the evidence for a causal relationship between innate immune system activation and organ injury after cardiac surgery is low.
目前尚不清楚先天性免疫反应是否代表心脏手术中器官保护策略的治疗靶点。
对针对心脏手术中炎症反应的干预措施进行了系统评价，这些干预措施报告了对先天性免疫系统细胞因子和器官损伤的治疗效果。该方案在国际前瞻性系统评价注册库中进行了注册：CRD42020187239。对 Cochrane 对照试验中心注册库、MEDLINE 和 Embase 进行了检索。主要分析采用随机效应荟萃分析。对来自六项研究（n=785）的个体患者数据的单独分析探讨了治疗对细胞因子水平的影响的异质性来源。
截至 2020 年 5 月的检索共确定了 251 项试验，纳入了 24 项干预措施，共涉及 20582 名参与者。大多数试验存在重要的局限性。纳入试验的方法学局限性和试验之间细胞因子水平治疗效果的异质性限制了其解释。主要分析表明，干预措施对先天性免疫和器官衰竭或死亡的治疗效果之间存在不一致的方向。对重要亚组或限制较少的试验进行分析得出了类似的结果。荟萃回归，对所有试验的数据进行汇总，表明炎症细胞因子治疗效果的方向与器官损伤或死亡之间没有关联。个体患者数据分析表明，对于年龄>75 岁的人和患有某些慢性疾病的人，细胞因子反应与心脏手术后器官损伤之间的相关性存在异质性。
先天性免疫系统激活与心脏手术后器官损伤之间因果关系的证据确定性较低。
