Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.
Melbourne Medical School, University of Melbourne, Parkville, Australia.
J Cardiothorac Surg. 2022 May 26;17(1):129. doi: 10.1186/s13019-022-01870-2.
Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac surgery patients.
Ovid Medline and Ovid Embase were searched from inception to July 2020 for studies evaluating the prognostic significance of PH following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each study and pooled using random effects inverse variance modelling to assess in-hospital mortality. Standardised mean differences were pooled to assess Intensive Care Unit (ICU) and hospital length of stay (LOS). Qualitative analysis was performed to assess ventilation requirements and long-term mortality. Meta-regression was used to assess inter- and intra-study heterogeneity.
3251 studies satisfied the selection criteria, from which 12 studies incorporating 3876 participants were included. PH significantly predicted in-hospital mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple pre-defined covariates contributed to the prognostic significance of PH, however only aortic cross-clamp time (p < 0.0001) and number of transfusions (p = 0.0001) were significant effect modifiers. PH significantly predicted both ICU LOS (Mean difference 1.32 [95% CI 0.04-2.6]) and hospital LOS (Mean difference 1.79 [95% CI 0.36-3.21]). Qualitative analysis suggested PH is associated with increased post-operative ventilation requirements and reduced long-term survival rates.
Hyperbilirubinemia is a cost-effective, widely available prognostic marker of adverse outcomes following cardiac surgery, albeit with residual sources of heterogeneity.
心脏手术后高胆红素血症是一种常见现象，在预后因素研究中受到越来越多的关注。本系统评价和荟萃分析评估了心脏手术后高胆红素血症（PH）与手术患者死亡率和发病率之间的关系。
从 Ovid Medline 和 Ovid Embase 数据库建库至 2020 年 7 月检索评估心脏手术后 PH 预后意义的研究。从每项研究中获取最大调整比值比（OR）及其相关置信区间，并使用随机效应逆方差模型进行汇总，以评估住院死亡率。汇总标准化均数差以评估重症监护病房（ICU）和住院时间（LOS）。进行定性分析以评估通气需求和长期死亡率。采用Meta 回归分析评估组间和组内异质性。
满足选择标准的 3251 项研究中，有 12 项研究纳入了 3876 名患者。PH 显著预测住院死亡率，汇总 OR 为 7.29（95%CI 3.53, 15.09）。多个预先定义的协变量有助于 PH 的预后意义，但只有主动脉阻断时间（p<0.0001）和输血次数（p=0.0001）是显著的效应修饰因子。PH 显著预测 ICU LOS（平均差 1.32 [95%CI 0.04-2.6]）和住院 LOS（平均差 1.79 [95%CI 0.36-3.21]）。定性分析表明，PH 与术后通气需求增加和长期生存率降低有关。
高胆红素血症是心脏手术后不良结局的一种经济有效、广泛可用的预后标志物，但仍存在异质性来源。
