Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.
Med Princ Pract. 2022;31(3):215-223. doi: 10.1159/000524435. Epub 2022 Apr 4.
Recent studies have increasingly shown the benefits of using sodium/glucose cotransporter 2 inhibitor (SGLT2i). However, there are concerns regarding the initiation of SGLT2i during acute hospital admissions due to the potential increased risk of complications. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of SGLT2i initiation within 2 weeks of an acute hospital admission.
Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched for articles published from inception up to 27 March 2021 that evaluated the efficacy and/or safety of SGLT2i initiation within 2 weeks of an acute hospital admission. Random-effects pair-wise meta-analysis models were utilized to summarize the studies. The protocol was registered with PROSPERO (CRD42021245492).
Nine clinical trials were included with a combined cohort of 1,758 patients. Patients receiving SGLT2i had a mean increase in 24-h urine volume of +487.55 mL (95% CI 126.86-848.25; p = 0.008) compared to those not started on SGLT2i. Patients with heart failure treated with SGLT2i had a 27% relative risk reduction in rehospitalizations for heart failure, compared to controls (risk ratio 0.73; p = 0.005). There were no differences in other efficacy and safety outcomes examined.
There was no increased harm with initiation of SGLT2i within 2 weeks of an acute hospital admission, and its use reduced the relative risk of rehospitalizations for heart failure in patients with heart failure. It was also associated with increased urine output. However, current evidence pool is limited, especially in specific population subtypes.
最近的研究越来越多地表明了使用钠/葡萄糖共转运蛋白 2 抑制剂（SGLT2i）的益处。然而，由于潜在的并发症风险增加，人们对急性住院期间开始使用 SGLT2i 存在担忧。我们进行了一项系统评价和荟萃分析，以评估急性住院后 2 周内开始使用 SGLT2i 的疗效和安全性。
检索了从建库至 2021 年 3 月 27 日发表的评估急性住院后 2 周内开始使用 SGLT2i 的疗效和/或安全性的 4 个电子数据库（PubMed、Embase、Cochrane 和 Scopus）中的文章。使用随机效应成对荟萃分析模型对研究进行总结。该方案已在 PROSPERO（CRD42021245492）上注册。
共纳入 9 项临床试验，共有 1758 例患者。与未开始使用 SGLT2i 的患者相比，开始使用 SGLT2i 的患者 24 小时尿量平均增加 487.55 毫升（95%CI 126.86-848.25；p=0.008）。与对照组相比，接受 SGLT2i 治疗的心力衰竭患者心力衰竭再住院的相对风险降低了 27%（风险比 0.73；p=0.005）。其他疗效和安全性结果无差异。
急性住院后 2 周内开始使用 SGLT2i 不会增加危害，并且其使用可降低心力衰竭患者心力衰竭再住院的相对风险。它还与增加尿量有关。然而，目前的证据有限，特别是在特定的人群亚组中。
