Doulamis Ilias P, Tzani Aspasia, Kampaktsis Polydoros N, Kaneko Tsuyoshi, Tang Gilbert H L
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
Cardiovasc Revasc Med. 2022 May;38:29-35. doi: 10.1016/j.carrev.2021.07.021. Epub 2021 Jul 23.
Aim of this study was to perform a systematic review a meta-analysis of the literature in order to identify predictors of acute kidney injury (AKI) in patients with mitral regurgitation (MR) undergoing transcatheter edge-to-edge repair (TEER) and assess its effect on in-hospital outcomes and mortality. Although iodinated contrast is not typically used in TEER, these patients are still at risk for developing AKI.
Studies reporting on the effect of incident AKI on mortality following TEER for MR were included. Random-effects meta-analysis was performed, comparing clinical outcomes between the patients with or without incident AKI.
Six studies including a total of 2057 patients (377 AKI and 1680 No-AKI) were included and analyzed. AKI was significantly associated with 30-day mortality after TEER (Odds ratio (OR): 8.06; 95% CI: 3.20, 20.30, p < 0.01; I = 18.4%) and all-cause mortality over a mean follow-up time of 30 months (Hazard ratio (HR): 2.48; 95% CI: 1.89, 3.24, p < 0.01; I = 23.7%). AKI after TEER was associated with prolonged hospitalization (Mean difference (in days): 1.41; 95% CI: 0.52, 2.31, p < 0.01; I = 82.4%). Stage 4 chronic kidney disease (CKD), device failure and history of chronic obstructive pulmonary disease (COPD) were significant predictors of AKI following TEER (CKD stage 4: OR: 2.38; 95% CI: 1.18, 4.78, p = 0.02; I = 0.0%; Device failure: OR: 3.15; 95% CI: 1.94, 5.12, p < 0.01; I = 0.0%; COPD: OR: 1.92; 95% CI: 1.16, 3.17; I = 26.7%).
Our findings highlight the renal vulnerability of the TEER population to renal injury and the associated deterioration in clinical outcomes and survival.
本研究旨在对文献进行系统评价和荟萃分析，以确定接受经导管缘对缘修复术（TEER）的二尖瓣反流（MR）患者急性肾损伤（AKI）的预测因素，并评估其对住院结局和死亡率的影响。尽管TEER通常不使用碘化造影剂，但这些患者仍有发生AKI的风险。
纳入报告TEER治疗MR后发生的AKI对死亡率影响的研究。进行随机效应荟萃分析，比较发生AKI和未发生AKI患者的临床结局。
纳入并分析了6项研究，共2057例患者（377例发生AKI，1680例未发生AKI）。AKI与TEER术后30天死亡率显著相关（比值比（OR）：8.06；95%置信区间（CI）：3.20，20.30，p<0.01；I² = 18.4%），以及平均随访30个月的全因死亡率（风险比（HR）：2.48；95% CI：1.89，3.24，p<0.01；I² = 23.7%）。TEER术后发生AKI与住院时间延长有关（平均差值（天数）：1.41；95% CI：0.52，2.31，p<0.01；I² = 82.4%）。4期慢性肾脏病（CKD）、器械故障和慢性阻塞性肺疾病（COPD）病史是TEER术后发生AKI的显著预测因素（CKD 4期：OR：2.38；95% CI：1.18，4.78，p = 0.02；I² = 0.0%；器械故障：OR：3.15；95% CI：1.94，5.12，p<0.01；I² = 0.0%；COPD：OR：1.92；95% CI：1.16，3.17；I² = 26.7%）。
我们的研究结果突出了TEER人群对肾损伤的肾脏易感性以及临床结局和生存的相关恶化。
