危重新生儿急性肾损伤的危险因素:系统评价与荟萃分析
Risk Factors for Acute Kidney Injury in Critically Ill Neonates: A Systematic Review and Meta-Analysis.
作者信息
Hu Qian, Li Shao-Jun, Chen Qian-Ling, Chen Han, Li Qiu, Wang Mo
机构信息
Department of Nephrology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Emergency Department, Children's Hospital of Chongqing Medical University, Chongqing, China.
出版信息
Front Pediatr. 2021 Jul 14;9:666507. doi: 10.3389/fped.2021.666507. eCollection 2021.
Acute kidney injury (AKI) is recognized as an independent risk factor for mortality and long-term poor prognosis in neonates. The objective of the study was to identify the risk factors for AKI in critically ill neonates to provide an important basis for follow-up research studies and early prevention. The PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang Med, SinoMed, and VIP Data were searched for studies of risk factors in critically ill neonates. Studies published from the initiation of the database to November 19, 2020, were included. The quality of studies was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) checklist. The meta-analysis was conducted with Stata 15 and drafted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Seventeen studies (five cohort studies, ten case-control studies, and two cross-sectional studies) were included in meta-analysis, with 1,627 cases in the case group and 5,220 cases in the control group. The incidence of AKI fluctuated from 8.4 to 63.3%. Fifteen risk factors were included, nine of which were significantly associated with an increased risk of AKI in critically ill neonates: gestational age [standardized mean difference (SMD) = -0.31, 95%CI = (-0.51, -0.12), = 0.002], birthweight [SMD = -0.37, 95%CI = (-0.67, -0.07), = 0.015], 1-min Apgar score [SMD = -0.61, 95%CI = (-0.78, -0.43), = 0.000], 5-min Apgar score [SMD = -0.71, 95%CI = (-1.00, -0.41), = 0.000], congenital heart disease (CHD) [odds ratio (OR) = 2.94, 95%CI = (2.08, 4.15), = 0.000], hyperbilirubinemia [OR = 2.26, 95%CI = (1.40, 3.65), = 0.001], necrotizing enterocolitis (NEC) [OR = 6.32, 95%CI = (2.98, 13.42), = 0.000], sepsis [OR = 2.21, 95%CI = (1.25, 3.89), = 0.006], and mechanical ventilation [OR = 2.37, 95%CI = (1.50, 3.75), = 0.000]. Six of them were not significantly associated with AKI in critically ill neonates: age [SMD = -0.25, 95%CI = (-0.54, 0.04), = 0.095], male sex [OR = 1.10, 95%CI =(0.97, 1.24), = 0.147], prematurity [OR = 0.90, 95%CI(0.52, 1.56), = 0.716], cesarean section [OR = 1.52, 95%CI(0.77, 3.01), = 0.234], prenatal hemorrhage [OR = 1.41, 95%CI = (0.86, 2.33), = 0.171], and vancomycin [OR = 1.16, 95%CI = (0.71, 1.89), = 0.555]. This meta-analysis provides a preliminary exploration of risk factors in critically ill neonatal AKI, which may be useful for the prediction of AKI. PROSPERO (CRD42020188032).
急性肾损伤(AKI)被认为是新生儿死亡和长期预后不良的独立危险因素。本研究的目的是确定危重新生儿发生AKI的危险因素,为后续研究和早期预防提供重要依据。通过检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方医学网、中国生物医学文献数据库和维普数据库,查找有关危重新生儿危险因素的研究。纳入从数据库建立至2020年11月19日发表的研究。采用纽卡斯尔-渥太华量表和医疗保健研究与质量局(AHRQ)清单评估研究质量。使用Stata 15进行荟萃分析,并根据系统评价和荟萃分析优先报告项目(PRISMA)声明的指南起草报告。荟萃分析纳入了17项研究(5项队列研究、10项病例对照研究和2项横断面研究),病例组有1627例,对照组有5220例。AKI的发生率在8.4%至63.3%之间波动。共纳入15个危险因素,其中9个与危重新生儿发生AKI的风险增加显著相关:胎龄[标准化均数差(SMD)=-0.31,95%可信区间(CI)=(-0.51,-0.12),P=0.002]、出生体重[SMD=-0.37,95%CI=(-0.67,-0.07),P=0.015]、1分钟阿氏评分[SMD=-0.61,95%CI=(-0.78,-0.43),P=0.000]、5分钟阿氏评分[SMD=-0.71,95%CI=(-1.00,-0.41),P=0.000]、先天性心脏病(CHD)[比值比(OR)=2.94,95%CI=(2.08,4.15),P=0.000]、高胆红素血症[OR=2.26,95%CI=(1.40,3.65),P=0.001]、坏死性小肠结肠炎(NEC)[OR=6.32,95%CI=(2.98,13.42),P=0.000]、脓毒症[OR=2.21,95%CI=(1.25,3.89),P=0.006]和机械通气[OR=2.37,95%CI=(1.50,3. July 2023 75),P=0.000]。其中6个与危重新生儿发生AKI无显著关联:年龄[SMD=-0.25,95%CI=(-0.54,0.04),P=0.095]、男性[OR=1.10,95%CI=(0.97,1.24),P=0.147] preterm birth [OR = 0.90, 95%CI(0.52, 1.56), = 0.716], cesarean section [OR = 1.52,95%CI(0.77, 3.01), = 0.234], prenatal hemorrhage [OR = 1.41, 95%CI = (0.86, 2.33), = 0.171], and vancomycin [OR = 1.16, 95%CI = (0.71, 1.89), = 0.555]. 这项荟萃分析对危重新生儿AKI的危险因素进行了初步探索,可能有助于预测AKI。国际前瞻性系统评价注册库(PROSPERO)登记号(CRD42020188032)。 (注:原文中“prematurity”在分析中说与AKI无显著关联,但前面又提到了“prematurity”,这里翻译时保留原文表述,可能存在一定的文本不严谨情况。)