超滤治疗急性失代偿性心力衰竭患者：系统评价和荟萃分析。

Ultrafiltration for patients with acute decompensated heart failure: A systematic review and meta-analysis.

机构信息

Emergency Department, General Hospital of Northern Theater Command, China.

China Medical University, China.

出版信息

Medicine (Baltimore). 2021 Dec 17;100(50):e28029. doi: 10.1097/MD.0000000000028029.

DOI:10.1097/MD.0000000000028029

PMID:34918656

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8677900/

Abstract

BACKGROUND

Ultrafiltration plays an indispensable role in relieving congestion and fluid retention in patients with acute decompensated heart failure (ADHF) in recent years. So far, there is no consistent agreement about whether early ultrafiltration (UF) is a first-line treatment for patients with ADHF. We, therefore, conducted a meta-analysis to assess the efficacy and safety of UF.

METHODS

PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) that compared UF with diuretics in patients with ADHF and included our interested outcomes. The primary outcomes are heart failure rehospitalization, all-cause rehospitalization, and mortality. The second outcomes are fluid loss, weight loss, and adverse events. RevMan Version 5.4.1 was used to analyze the data of included studies.

RESULTS

A total of 12 studies with 1197 patients were included. Our results showed a reduction in heart failure rehospitalization (risk ratio [RR] 0.67, 95% confidence interval [CI]: 0.52-0.87, P = .003) and all-cause rehospitalization (RR 0.62, 95% CI: 0.42-0.92; P = .02), an increase in fluid loss (1.47 L, 95% CI: 0.95-1.99 L, P < .001) and weight loss (1.65 kg, 95% CI: 0.90-2.41 kg; P < .001). There was no difference in mortality (RR 1.09, 95% CI: 0.78-1.51; P = .62). There were inconsistent agreements about which group have more total adverse events. Subgroup analysis showed that UF with larger mean fluid-remove rate (≥200 mL/h) could significantly remove more fluid, lose more weight, and decrease heart failure rehospitalization. Less weight loss for patients with ADHF may correlated to higher percent of ischemic etiology (ischemic etiology ≥50%).

CONCLUSION

Although UF is more effective in removing fluid than diuretics and decrease rehospitalization of heart failure and all causes, there is not enough evidence to prove that UF is superior because of adverse events and mortality in the UF group. The mean fluid-removal rates should be set to ≥200 mL/h. Patient with different etiology may have different effects when treated with UF and it is a weak conclusion.Trial registration: The systematic review was registered with the International Prospective Registry of Systematic Reviews. (https://www.crd.york.ac.uk/prospero/, registration number CRD42021245049).

摘要

背景

超滤在近年来急性失代偿性心力衰竭（ADHF）患者的充血和液体潴留缓解中发挥着不可或缺的作用。到目前为止，对于早期超滤（UF）是否是 ADHF 患者的一线治疗方法，尚无一致的共识。因此，我们进行了一项荟萃分析来评估 UF 的疗效和安全性。

方法

我们检索了 PubMed、Embase 和 Cochrane 图书馆数据库中的随机对照试验（RCT），这些 RCT 将 UF 与 ADHF 患者的利尿剂进行了比较，并纳入了我们感兴趣的结局。主要结局是心力衰竭再住院、全因再住院和死亡率。次要结局是液体丢失、体重减轻和不良事件。使用 RevMan Version 5.4.1 分析纳入研究的数据。

结果

共纳入 12 项研究，共计 1197 例患者。我们的结果显示，心力衰竭再住院率（风险比 [RR] 0.67，95%置信区间 [CI]：0.52-0.87，P=0.003）和全因再住院率（RR 0.62，95% CI：0.42-0.92；P=0.02）降低，液体丢失量（1.47 L，95% CI：0.95-1.99 L，P<0.001）和体重减轻量（1.65 kg，95% CI：0.90-2.41 kg；P<0.001）增加。死亡率无差异（RR 1.09，95% CI：0.78-1.51；P=0.62）。关于哪个组发生的总不良事件更多，存在不一致的意见。亚组分析显示，超滤时采用较大的平均液体去除率（≥200 mL/h）可以显著去除更多的液体，减轻更多的体重，并降低心力衰竭再住院率。ADHF 患者体重减轻较少可能与缺血性病因的比例较高（缺血性病因≥50%）有关。