围手术期促红细胞生成素给药对心脏手术患者急性肾损伤和红细胞输血的影响：系统评价和荟萃分析。

Effects of perioperative erythropoietin administration on acute kidney injury and red blood cell transfusion in patients undergoing cardiac surgery: A systematic review and meta-analysis.

机构信息

Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.

Department of Preventive Medicine, Institute for Evidence-based Medicine Cochrane Korea, Republic of Korea.

出版信息

Medicine (Baltimore). 2022 Mar 4;101(9):e28920. doi: 10.1097/MD.0000000000028920.

DOI:10.1097/MD.0000000000028920

PMID:35244046

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8896477/

Abstract

BACKGROUND

The renoprotective effects of erythropoietin (EPO) are well-known; however, the optimal timing of EPO administration remains controversial. Red blood cell (RBC) transfusion is an independent risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to evaluate the efficacy of EPO on CSA-AKI and RBC transfusion according to the timing of administration.

METHODS

We searched the Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled trials. The primary outcome was the incidence of CSA-AKI following perioperative EPO administration, and the secondary outcomes were changes in serum creatinine, S-cystatin C, S-neutrophil gelatinase-associated lipocalin, urinary neutrophil gelatinase-associated lipocalin, length of hospital and intensive care unit (ICU) stay, volume of RBC transfusion, and mortality. The subgroup analysis was stratified according to the timing of EPO administration in relation to surgery.

RESULTS

Eight randomized controlled trials with 610 patients were included in the study. EPO administration significantly decreased the incidence of CSA-AKI (odds ratio: 0.60, 95% confidence interval [CI]: 0.43-0.85, P = .004; I2 = 52%; P for heterogeneity = .04), intra-operative RBC transfusion (standardized mean difference: -0.30, 95% CI: -0.55 to -0.05, P = .02; I2 = 15%, P for heterogeneity = .31), and hospital length of stay (mean difference: -1.54 days, 95% CI: -2.70 to -0.39, P = .009; I2 = 75%, P for heterogeneity = .001) compared with control groups. Subgroup analyses revealed that pre-operative EPO treatment significantly reduced the incidence of CSA-AKI, intra-operative RBC transfusion, serum creatinine, and length of hospital and ICU stay.

CONCLUSION

Pre-operative administration of EPO may reduce the incidence of CSA-AKI and RBC transfusion, but not in patients administered EPO during the intra-operative or postoperative period. Therefore, pre-operative EPO treatment can be considered to improve postoperative outcomes by decreasing the length of hospital and ICU stay in patients undergoing cardiac surgery.

摘要

背景

促红细胞生成素（EPO）具有肾保护作用，这一点已得到广泛认可；然而，EPO 的最佳给药时机仍存在争议。红细胞（RBC）输注是心脏手术相关急性肾损伤（CSA-AKI）的独立危险因素。我们旨在评估根据给药时机，EPO 对 CSA-AKI 和 RBC 输注的疗效。

方法

我们检索了 Cochrane 图书馆、EMBASE 和 MEDLINE 数据库中的随机对照试验。主要结局是围手术期 EPO 给药后 CSA-AKI 的发生率，次要结局是血清肌酐、S-胱抑素 C、S-中性粒细胞明胶酶相关脂质运载蛋白、尿中性粒细胞明胶酶相关脂质运载蛋白、住院和重症监护病房（ICU）停留时间、RBC 输注量和死亡率的变化。亚组分析根据 EPO 给药与手术的时间关系进行分层。

结果

共有 8 项随机对照试验，纳入 610 例患者。EPO 给药可显著降低 CSA-AKI 的发生率（比值比：0.60，95%置信区间[CI]：0.43-0.85，P=0.004；I2=52%；P 异质性=0.04）、术中 RBC 输注（标准化均数差：-0.30，95%CI：-0.55 至-0.05，P=0.02；I2=15%，P 异质性=0.31）和住院时间（平均差：-1.54 天，95%CI：-2.70 至-0.39，P=0.009；I2=75%，P 异质性=0.001），与对照组相比。亚组分析显示，术前 EPO 治疗可显著降低 CSA-AKI、术中 RBC 输注、血清肌酐和住院及 ICU 住院时间的发生率。